Inoue Ken, Yoshida Naohisa, Dohi Osamu, Sugino Satoshi, Matsumura Shinya, Kitae Hiroaki, Yasuda Ritsu, Nakano Takahiro, Terasaki Kei, Hirose Ryohei, Naito Yuji, Murakami Takaaki, Inada Yutaka, Ogiso Kiyoshi, Morinaga Yukiko, Kishimoto Mitsuo, Yoshito Itoh
Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Department of Gastroenterology, Nara City Hospital, Nara, Japan.
Endosc Int Open. 2021 Nov 12;9(11):E1617-E1626. doi: 10.1055/a-1535-0786. eCollection 2021 Nov.
This study evaluated the technical aspects of colorectal endoscopic submucosal dissection (ESD) with the Clutch Cutter (CC) (Fujifilm Co., Tokyo, Japan), a scissor-type knife, and the S-O clip (SO) as a traction clip, and compared the safety and efficacy to ESD using a needle-type knife. This was a single-center retrospective study. In Study 1, we evaluated 125 ESD patients: 60 using the SO and CC (SO group) and 65 using the CC (CC group). In Study 2, we evaluated 185 ESD patients: the CC group (N = 65) and 120 using the Flush knife BT-S (Flush group) (Fujifilm Co., Tokyo, Japan). In both studies, the clinicopathological features and therapeutic outcomes were compared using a propensity score-matched analysis. In 36 pairs of matched patients in Study 1, the rates of en bloc resection, R0 resection, perforation, and postoperative bleeding (POB) were 97.2 %, 88.9 %, 2.8 %, and 0 %, respectively, for the SO group and 100 %, 91.7 %, 0 %, and 0 % for the CC group (not significant). The mean procedure time for the SO group among less-experienced endoscopists was significantly shorter than in the CC group (42 vs. 65 minutes, = 0.036). In 49 pairs of matched patients in Study 2, the rates of en bloc resection, R0 resection, perforation, and POB were 100 %, 95.8 %, 0 %, and 0 %, respectively, for the CC group and 98.0 %, 95.8 %, 0 %, and 2.0 % for the Flush group (not significant). The mean procedure time in the CC group among less-experienced endoscopists was significantly shorter than in the Flush group (52 vs. 67 minutes, = 0.038). CC and the combined use of CC and SO reduced colorectal ESD procedure time among less-experienced endoscopists.
本研究评估了使用剪刀型刀具Clutch Cutter（CC）（日本东京富士胶片公司）和作为牵引夹的S-O夹（SO）进行大肠内镜黏膜下剥离术（ESD）的技术方面，并将其安全性和有效性与使用针型刀进行ESD进行比较。这是一项单中心回顾性研究。在研究1中，我们评估了125例ESD患者：60例使用SO和CC（SO组），65例仅使用CC（CC组）。在研究2中，我们评估了185例ESD患者：CC组（N = 65）和120例使用Flush knife BT-S（Flush组）（日本东京富士胶片公司）。在两项研究中，使用倾向评分匹配分析比较临床病理特征和治疗结果。在研究1的36对匹配患者中，SO组的整块切除率、R0切除率、穿孔率和术后出血（POB）率分别为97.2%、88.9%、2.8%和0%，CC组分别为100%、91.7%、0%和0%（无显著差异）。经验不足的内镜医师中，SO组的平均手术时间显著短于CC组（42分钟对65分钟，P = 0.036）。在研究2的49对匹配患者中，CC组的整块切除率、R0切除率、穿孔率和POB率分别为100%、95.8%、0%和0%，Flush组分别为98.0%、95.8%、0%和2.0%（无显著差异）。经验不足的内镜医师中，CC组的平均手术时间显著短于Flush组（52分钟对67分钟，P = 0.038）。CC以及CC与SO联合使用可缩短经验不足的内镜医师进行大肠ESD的手术时间。
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