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Endoscopic Submucosal Dissection for Early Gastric Cancer using the Clutch
Cutter: a large single-center experience
#MMPMID26528497
Akahoshi K
; Motomura Y
; Kubokawa M
; Gibo J
; Kinoshita N
; Osada S
; Tokumaru K
; Hosokawa T
; Tomoeda N
; Otsuka Y
; Matsuo M
; Oya M
; Koga H
; Nakamura K
Endosc Int Open
2015[Oct]; 3
(5
): E432-8
PMID26528497
show ga
BACKGROUND AND STUDY AIMS: The Clutch Cutter (CC) was developed to reduce the
risk of complications related to endoscopic submucosal dissection (ESD) using
knives. The CC is able to grasp and coagulate and/or incise the targeted tissue
using electrosurgical current, like a biopsy technique. The aim of this study was
to evaluate the efficacy and safety of ESD using the CC (ESD-CC) for early
gastric cancer (EGC). PATIENTS AND METHODS: From June 2007 to March 2014, 325
consecutive patients with a diagnosis of EGC were enrolled in this prospective
study. They had all satisfied the Japanese gastric cancer treatment guidelines
for ESD indication, namely confirmation by preliminary endoscopy, endoscopic
ultrasound, and endoscopic biopsies. The CC was used for all steps of ESD
(marking, circumferential marginal incision, submucosal dissection, and
hemostatic treatment). The therapeutic efficacy and safety were assessed.
RESULTS: The en-bloc resection rate was 99.7?% (324/325) and the R0 resection
rate was 95.3?% (310/325). The mean operating time was 97.2 minutes. Perforation
during ESD-CC occurred in one case (0.3?%), which was managed with conservative
medical treatment after endoscopic closure of the perforation. Post-ESD-CC
bleeding occurred in 11 cases (3.4?%), which were successfully treated by
endoscopic hemostatic treatment. The R0 resection rate was significantly low in
tumors?>?20?mm (88.9?%), and in the exclusion indication group (73.7?%).
Significant differences were seen in the mean operating time, depending upon
tumor size, histologic type, location, and indication criteria. CONCLUSIONS:
ESD-CC is a technically efficient, safe, and easy method for resecting EGC.
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