Yachida Tatsuo, Kobara Hideki, Kozuka Kazuhiro, Nakatani Kaho, Tada Naoya, Matsui Takanori, Chiyo Taiga, Kobayashi Nobuya, Fujihara Shintaro, Nishiyama Noriko, Kondo Akihiro, Ando Yasuhisa, Okano Keiichi, Nonaka Wakako, Ishikawa Kaori, Masugata Hisashi, Masaki Tsutomu
Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita 761-0793, Kagawa, Japan.
Department of General Internal Medicine, Faculty of Medicine, Kagawa University, Kita 761-0793, Kagawa, Japan.
J Clin Med. 2023 Mar 16;12(6):2329. doi: 10.3390/jcm12062329.
To evaluate the efficacy and safety of a grasping-type knife, called Clutch Cutter (CC), for colorectal endoscopic submucosal dissection (C-ESD).
This was a randomized prospective study. Patients who underwent C-ESD for colorectal neoplasms >20 mm and <50 mm in size were enrolled, dividing into two groups: ESD using needle type of dual knife alone (D-group) and circumferential incision using dual knife followed by submucosal dissection using CC (CC-group). The primary outcome was the self-completion rate. The secondary outcomes were intraoperative complication rate, procedure time, and en bloc resection rate.
A total of 45 patients were allocated to the D-group and 43 to the CC-group were allocated. The self-completion rate was higher in the CC-group (87% [39/45] vs. 98% [42/43]). All of the six patients with an incomplete procedure in the D-group were completely resected with CC use. The intraoperative complication rate was not significant in either group (D vs. CC: 2% vs. 0%). The mean procedure time was significantly shorter in the D-group than that in the CC-group (62.0 vs. 81.1 min; = 0.0036). The en bloc resection rate was 100% in the D-group and 98% in the CC-group.
While dual knife use is superior to CC in terms of time efficiency, the use of CC may be a safe and efficacious option for achieving complete C-ESD.
评估一种名为抓持型刀（Clutch Cutter，CC）的器械用于结直肠内镜黏膜下剥离术（C-ESD）的有效性和安全性。
这是一项随机前瞻性研究。纳入因结直肠肿瘤大小>20 mm且<50 mm而接受C-ESD的患者，分为两组：单纯使用针型双刀进行ESD（D组）和先用双刀进行环周切开，然后用CC进行黏膜下剥离（CC组）。主要结局是自我完成率。次要结局是术中并发症发生率、手术时间和整块切除率。
共45例患者被分配至D组，43例被分配至CC组。CC组的自我完成率更高（87%[39/45]对98%[42/43]）。D组6例手术未完成的患者在使用CC后均实现了完全切除。两组术中并发症发生率均无显著差异（D组对CC组：2%对0%）。D组的平均手术时间显著短于CC组（62.0对81.1分钟；P = 0.0036）。D组的整块切除率为100%，CC组为98%。
虽然在时间效率方面，使用双刀优于CC，但使用CC可能是实现完整C-ESD的一种安全有效的选择。
