Akahoshi Kazuya, Komori Keishi, Akahoshi Kazuaki, Tamura Shinichi, Osada Shigeki, Shiratsuchi Yuki, Kubokawa Masaru
Endoscopy Center, Aso Iizuka Hospital, Iizuka 820-8505, Japan.
Department of Gastroenterology, Aso Iizuka Hospital, Iizuka 820-8505, Japan.
World J Gastrointest Surg. 2021 Aug 27;13(8):772-787. doi: 10.4240/wjgs.v13.i8.772.
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 gastrointestinal 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 ( 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 non-experts was significantly better with the CC than with conventional knives (61.7% 24.5%, respectively; < 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.
内镜黏膜下剥离术（ESD）是一种全球公认的用于早期胃肠道肿瘤的微创治疗方法。尽管已经开发出多种用于ESD的电外科刀，但技术难题和高并发症发生率（出血和穿孔）限制了它们在全球范围内的应用。抓持型剪刀钳[离合切割器（CC）]是首款参照止血钳开发的钳型切除装置。其目的是作为一种活检技术，使用一种装置在整个胃肠道实现简便、安全的ESD。CC能够在对组织通电之前准确抓取目标组织并将其从下方肌肉层拉开，从而在ESD期间实现安全有效的切割和止血。已报道的临床研究表明，使用CC的ESD（ESD-CC）是一种安全的（穿孔率：0%-3.6%；延迟出血率：0%-4.2%）、技术上高效的（切除率：88.9%-100%）、用于切除早期胃肠道肿瘤的单装置方法。ESD-CC技术简单易学，因为只需通过使用电外科电流重复抓取、牵拉、凝固和/或切割动作即可完成。非专家报告的自我完成率使用CC时明显优于传统刀具（分别为61.7%和24.5%；<0.001）。此外，CC还用于其他内镜治疗，如大型带蒂息肉的内镜下息肉切除术、Zenker憩室的内镜下肌切开术、埋藏式吻合器综合征的内镜治疗以及壁内型胰腺坏死的内镜下坏死组织切除术。关于使用CC进行这些治疗的初步报告已显示出良好效果。在本综述中，我们描述了CC的结构特点、该器械的使用方法、ESD-CC的疗效以及使用CC的其他独特内镜治疗方法。
