AIM To evaluate the clinical outcome of endoscopic submucosal dissection using the Clutch Cutter(ESDCC) in older patients. METHODS We reviewed 232 consecutive patients with early gastric cancer who underwent ESDCC bet...AIM To evaluate the clinical outcome of endoscopic submucosal dissection using the Clutch Cutter(ESDCC) in older patients. METHODS We reviewed 232 consecutive patients with early gastric cancer who underwent ESDCC between June 2010 and February 2014 at Aso Iizuka Hospital. We divided patients into two groups according to age: Older patients(> 80 years, n = 64) and non-older patients(≤ 80 years, n = 168). We retrospectively compared the prevalence rates of pre-existing comorbidities, anticoagulant therapy, en bloc resection, mean duration of hospitalization, incidence of ESDCC-related complications, change in performance status(PS) before and after ESDCC, and financial cost of admission. RESULTS The older group comprised 64 patients with a mean age of 84.1 years, and the non-older group comprised 168 patients with a mean age of 69.5 years. Older patients had significantly more pre-existing comorbidities than did non-older patients, specifically heart disease(P < 0.05). The en bloc resection rate in non-older patients was significantly higher than that in older patients(100% vs 95.3%, P = 0.02). There were no significant differences between the older and non-older groups in the incidence of ESDCC-related complications(i.e., postoperative bleeding and perforation) and the post-ESDCC change in PS. There were also no significant differences between the older and non-older groups in the mean duration of hospitalization(11.4 and 10.7 d, respectively) and financial cost of admission(657040 JPY and 574890 JPY, respectively).CONCLUSION ESDCC has a good clinical outcome in older patients.展开更多
BACKGROUND A clutch cutter is a scissor-type knife used in endoscopic submucosal dissection(ESD)for gastrointestinal tract tumors.The assistant during the ESD using a clutch cutter(ESD-C)needs to rotate the device and...BACKGROUND A clutch cutter is a scissor-type knife used in endoscopic submucosal dissection(ESD)for gastrointestinal tract tumors.The assistant during the ESD using a clutch cutter(ESD-C)needs to rotate the device and grasp the target tissue appropriately;therefore,the assistant’s skill may affect the technical outcomes of ESD-C.AIM To determine how assistant skill level affected the technical outcomes of gastric ESD-C using an ex vivo porcine training model.METHODS In this pilot study,mock lesions of 15-30 mm in diameter were created in the middle or lower third of the porcine stomach.A total of 32 ESD-C procedures were performed by 16 trainees.Each trainee operator performed two ESD-C procedures;one ESD-C was assisted by an expert(ESD-C-E),and the other was assisted by a non-expert(ESD-C-NE).The total procedure time of the ESD was set as the primary outcome,and en bloc resection rate,complete procedure rate,perforation rate,and each procedure time/speed for mucosal incision or submucosal dissection were set as the secondary outcomes.In addition,we investigated factors associated with the difficulty of ESD including incompletion of ESD procedure,a long procedure time(≥20 min)or intraoperative perforation.RESULTS The median total procedure time of the ESD-C-E was significantly shorter than that of the ESD-C-NE(12.9 min vs 21.9 min,P=0.001).The en bloc resection rate was 100%in both groups.Complete resection rates of the ESD-C-E and ESD-C-NE groups were 100%and 93.8%,respectively.No intraoperative perforation was observed in both groups.In the multivariate analysis,assistant skill was significantly associated with the difficulty of ESD,with the highest odds ratio of 16.5.CONCLUSION Assistance by an expert is an important factor when trainees perform ESD-C procedures.展开更多
To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) using the clutch cutter (CC) (ESD-CC) for gastric adenoma (GA). METHODSFrom June 2007 to August 2015, 122 consecutive patients with histolo...To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) using the clutch cutter (CC) (ESD-CC) for gastric adenoma (GA). METHODSFrom June 2007 to August 2015, 122 consecutive patients with histological diagnoses of GA from specimens resected by ESD-CC were enrolled in this prospective study. The CC was used for all ESD steps (marking, mucosal incision, submucosal dissection, and hemostatic treatment), and its therapeutic efficacy and safety were assessed. RESULTSBoth the en-bloc resection rate and the R0 resection rate were 100% (122/122). The mean surgical time was 77.4 min, but the time varied significantly according to tumor size and location. No patients suffered perforation. Post-ESD-CC bleeding occurred in six cases (4.9%) that were successfully resolved by endoscopic hemostatic treatment. CONCLUSIONESD-CC is a technically efficient, safe, and easy method for resecting GA.展开更多
Endoscopic submucosal dissection (ESD) with a knife is a technically demanding procedure associated with a high complication rate.The shortcomings of this method are the deficiencies of fixing the knife to the target ...Endoscopic submucosal dissection (ESD) with a knife is a technically demanding procedure associated with a high complication rate.The shortcomings of this method are the deficiencies of fixing the knife to the target lesion,and of compressing it.These shortcomings can lead to major complications such as perforation and bleeding.To reduce the risk of complications related to ESD,we developed a new grasping type scissors forceps (Clutch Cutter,Fujifilm,Japan) which can grasp and incise the targeted tissue using an electrosurgical current.Esophagogastroduodenoscopy on a 59-year-old Japanese man revealed a 16mm esophageal submucosal nodule with central depression.Endoscopic ultrasonography demonstrated a hypoechoic solid tumor limited to the submucosa without lymph node involvement.The histologic diagnosis of the specimen obtained by biopsy was granular cell tumor.It was safely and accurately resected without unexpected incision by ESD using the CC.No delayed hemorrhage or perforation occurred.Histological examination confirmed that the granular cell tumor was completely excised with negative resection margin.We report herein a case of esophageal granular cell tumor successfully treated by an ESD technique using the CC.展开更多
AIM To compare the outcomes of endoscopic submucosal dissection(ESD) for gastric neoplasms using Clutch Cutter(ESD-C) or other knives(ESD-O).METHODS This was a single-center retrospective study. Gastric neoplasms trea...AIM To compare the outcomes of endoscopic submucosal dissection(ESD) for gastric neoplasms using Clutch Cutter(ESD-C) or other knives(ESD-O).METHODS This was a single-center retrospective study. Gastric neoplasms treated by ESD between April 2016 and October 2017 at Kitakyushu Municipal Medical Center were reviewed. Multivariate analyses and propensity score matching were used to reduce biases. Covariates included factors that might affect outcomes of ESD, including age, sex, underlying disease, anti-thrombotic drugs use, tumor location, tumor position, tumor size, tumor depth, tumor morphology, tumor histology, ulcer(scar), and operator skill. The treatment outcomes were compared among two groups. The primary outcome was ESD procedure time. Secondary outcomes were en bloc, complete, and curative resection rates, and adverse events rates including perforation and delayed bleeding.RESULTS A total of 155 patients were included in this study; 44 pairs were created by propensity score matching. Background characteristics were quite similar among two groups after matching. Procedure time was significantly shorter for ESD-C(median; 49 min) than for ESD-O(median; 88.5 min)(P < 0.01). However, there was no significant difference in treatment outcomes between ESD-C and ESD-O including en bloc resection rate(100% in both groups), complete resection rate(100% in both groups), curative resection rate(86.4% vs 88.6%, P = 0.730), delayed bleeding(2.3% vs 6.8%, P = 0.62) and perforation(0% in both groups).CONCLUSION ESD-C achieved shorter procedure time without an increase in complication risk. Therefore, ESD-C could become an effective ESD option for gastric neoplasms.展开更多
Endoscopic submucosal dissection(ESD)is a globally accepted minimally invasive therapy for early-stage gastrointestinal tract tumors.Although numerous electrosurgical knives have been developed for ESD,technical diffi...Endoscopic submucosal dissection(ESD)is a globally accepted minimally invasive therapy for early-stage gastrointestinal tract tumors.Although numerous electrosurgical knives have been developed for ESD,technical difficulties and high complication rates(bleeding and perforation)have limited their use worldwide.The grasping-type scissors forceps[clutch cutter(CC)]is the first forceps-type resection device developed with reference to hemostatic forceps.The aim was to allow easy and safe ESD throughout the gastro-intestinal tract,as a biopsy technique,using one device.The CC can grasp the target tissue accurately and pull it away from the underlying muscle layer prior to energizing the tissue,for safe and effective incision and hemostasis during ESD.Reported clinical studies showed that ESD using the CC(ESD-CC)is a safe(perforation rate:0%-3.6%;delayed bleeding rate:0%-4.2%),technically efficient(en-bloc resection rate:88.9%-100%),and single-device method for dissecting early-stage gastrointestinal tract tumors.The ESD-CC technique is simple and easy to learn because it can be completed simply by repeating the grasp,pull,and coagulate and/or incise actions using an electrosurgical current.The reported self-completion rate by nonexperts was significantly better with the CC than with conventional knives(61.7%vs 24.5%,respectively;P<0.001).Furthermore,the CC is used for other endoscopic therapies,such as endoscopic polypectomy for large pedunculated polyps,endoscopic myotomy for Zenker’s diverticulum,endoscopic treatment of buried bumper syndrome,and endoscopic necrosectomy for wall-off pancreatic necrosis.The initial reports using CC for these therapies have shown favorable results.In this review,we describe the structural features of the CC,how to use the instrument,efficacies of ESD-CC,and other unique endoscopic therapies using the CC.展开更多
文摘AIM To evaluate the clinical outcome of endoscopic submucosal dissection using the Clutch Cutter(ESDCC) in older patients. METHODS We reviewed 232 consecutive patients with early gastric cancer who underwent ESDCC between June 2010 and February 2014 at Aso Iizuka Hospital. We divided patients into two groups according to age: Older patients(> 80 years, n = 64) and non-older patients(≤ 80 years, n = 168). We retrospectively compared the prevalence rates of pre-existing comorbidities, anticoagulant therapy, en bloc resection, mean duration of hospitalization, incidence of ESDCC-related complications, change in performance status(PS) before and after ESDCC, and financial cost of admission. RESULTS The older group comprised 64 patients with a mean age of 84.1 years, and the non-older group comprised 168 patients with a mean age of 69.5 years. Older patients had significantly more pre-existing comorbidities than did non-older patients, specifically heart disease(P < 0.05). The en bloc resection rate in non-older patients was significantly higher than that in older patients(100% vs 95.3%, P = 0.02). There were no significant differences between the older and non-older groups in the incidence of ESDCC-related complications(i.e., postoperative bleeding and perforation) and the post-ESDCC change in PS. There were also no significant differences between the older and non-older groups in the mean duration of hospitalization(11.4 and 10.7 d, respectively) and financial cost of admission(657040 JPY and 574890 JPY, respectively).CONCLUSION ESDCC has a good clinical outcome in older patients.
文摘BACKGROUND A clutch cutter is a scissor-type knife used in endoscopic submucosal dissection(ESD)for gastrointestinal tract tumors.The assistant during the ESD using a clutch cutter(ESD-C)needs to rotate the device and grasp the target tissue appropriately;therefore,the assistant’s skill may affect the technical outcomes of ESD-C.AIM To determine how assistant skill level affected the technical outcomes of gastric ESD-C using an ex vivo porcine training model.METHODS In this pilot study,mock lesions of 15-30 mm in diameter were created in the middle or lower third of the porcine stomach.A total of 32 ESD-C procedures were performed by 16 trainees.Each trainee operator performed two ESD-C procedures;one ESD-C was assisted by an expert(ESD-C-E),and the other was assisted by a non-expert(ESD-C-NE).The total procedure time of the ESD was set as the primary outcome,and en bloc resection rate,complete procedure rate,perforation rate,and each procedure time/speed for mucosal incision or submucosal dissection were set as the secondary outcomes.In addition,we investigated factors associated with the difficulty of ESD including incompletion of ESD procedure,a long procedure time(≥20 min)or intraoperative perforation.RESULTS The median total procedure time of the ESD-C-E was significantly shorter than that of the ESD-C-NE(12.9 min vs 21.9 min,P=0.001).The en bloc resection rate was 100%in both groups.Complete resection rates of the ESD-C-E and ESD-C-NE groups were 100%and 93.8%,respectively.No intraoperative perforation was observed in both groups.In the multivariate analysis,assistant skill was significantly associated with the difficulty of ESD,with the highest odds ratio of 16.5.CONCLUSION Assistance by an expert is an important factor when trainees perform ESD-C procedures.
文摘To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) using the clutch cutter (CC) (ESD-CC) for gastric adenoma (GA). METHODSFrom June 2007 to August 2015, 122 consecutive patients with histological diagnoses of GA from specimens resected by ESD-CC were enrolled in this prospective study. The CC was used for all ESD steps (marking, mucosal incision, submucosal dissection, and hemostatic treatment), and its therapeutic efficacy and safety were assessed. RESULTSBoth the en-bloc resection rate and the R0 resection rate were 100% (122/122). The mean surgical time was 77.4 min, but the time varied significantly according to tumor size and location. No patients suffered perforation. Post-ESD-CC bleeding occurred in six cases (4.9%) that were successfully resolved by endoscopic hemostatic treatment. CONCLUSIONESD-CC is a technically efficient, safe, and easy method for resecting GA.
文摘Endoscopic submucosal dissection (ESD) with a knife is a technically demanding procedure associated with a high complication rate.The shortcomings of this method are the deficiencies of fixing the knife to the target lesion,and of compressing it.These shortcomings can lead to major complications such as perforation and bleeding.To reduce the risk of complications related to ESD,we developed a new grasping type scissors forceps (Clutch Cutter,Fujifilm,Japan) which can grasp and incise the targeted tissue using an electrosurgical current.Esophagogastroduodenoscopy on a 59-year-old Japanese man revealed a 16mm esophageal submucosal nodule with central depression.Endoscopic ultrasonography demonstrated a hypoechoic solid tumor limited to the submucosa without lymph node involvement.The histologic diagnosis of the specimen obtained by biopsy was granular cell tumor.It was safely and accurately resected without unexpected incision by ESD using the CC.No delayed hemorrhage or perforation occurred.Histological examination confirmed that the granular cell tumor was completely excised with negative resection margin.We report herein a case of esophageal granular cell tumor successfully treated by an ESD technique using the CC.
文摘AIM To compare the outcomes of endoscopic submucosal dissection(ESD) for gastric neoplasms using Clutch Cutter(ESD-C) or other knives(ESD-O).METHODS This was a single-center retrospective study. Gastric neoplasms treated by ESD between April 2016 and October 2017 at Kitakyushu Municipal Medical Center were reviewed. Multivariate analyses and propensity score matching were used to reduce biases. Covariates included factors that might affect outcomes of ESD, including age, sex, underlying disease, anti-thrombotic drugs use, tumor location, tumor position, tumor size, tumor depth, tumor morphology, tumor histology, ulcer(scar), and operator skill. The treatment outcomes were compared among two groups. The primary outcome was ESD procedure time. Secondary outcomes were en bloc, complete, and curative resection rates, and adverse events rates including perforation and delayed bleeding.RESULTS A total of 155 patients were included in this study; 44 pairs were created by propensity score matching. Background characteristics were quite similar among two groups after matching. Procedure time was significantly shorter for ESD-C(median; 49 min) than for ESD-O(median; 88.5 min)(P < 0.01). However, there was no significant difference in treatment outcomes between ESD-C and ESD-O including en bloc resection rate(100% in both groups), complete resection rate(100% in both groups), curative resection rate(86.4% vs 88.6%, P = 0.730), delayed bleeding(2.3% vs 6.8%, P = 0.62) and perforation(0% in both groups).CONCLUSION ESD-C achieved shorter procedure time without an increase in complication risk. Therefore, ESD-C could become an effective ESD option for gastric neoplasms.
文摘Endoscopic submucosal dissection(ESD)is a globally accepted minimally invasive therapy for early-stage gastrointestinal tract tumors.Although numerous electrosurgical knives have been developed for ESD,technical difficulties and high complication rates(bleeding and perforation)have limited their use worldwide.The grasping-type scissors forceps[clutch cutter(CC)]is the first forceps-type resection device developed with reference to hemostatic forceps.The aim was to allow easy and safe ESD throughout the gastro-intestinal tract,as a biopsy technique,using one device.The CC can grasp the target tissue accurately and pull it away from the underlying muscle layer prior to energizing the tissue,for safe and effective incision and hemostasis during ESD.Reported clinical studies showed that ESD using the CC(ESD-CC)is a safe(perforation rate:0%-3.6%;delayed bleeding rate:0%-4.2%),technically efficient(en-bloc resection rate:88.9%-100%),and single-device method for dissecting early-stage gastrointestinal tract tumors.The ESD-CC technique is simple and easy to learn because it can be completed simply by repeating the grasp,pull,and coagulate and/or incise actions using an electrosurgical current.The reported self-completion rate by nonexperts was significantly better with the CC than with conventional knives(61.7%vs 24.5%,respectively;P<0.001).Furthermore,the CC is used for other endoscopic therapies,such as endoscopic polypectomy for large pedunculated polyps,endoscopic myotomy for Zenker’s diverticulum,endoscopic treatment of buried bumper syndrome,and endoscopic necrosectomy for wall-off pancreatic necrosis.The initial reports using CC for these therapies have shown favorable results.In this review,we describe the structural features of the CC,how to use the instrument,efficacies of ESD-CC,and other unique endoscopic therapies using the CC.
