Background/Aims: The purpose of this study was to evaluate the safety and efficacy of gastric endoscopic submucosal dissection (ESD) using the Clutch Cutter (CC), a scissor-type knife, compared with those of procedures using conventional devices. Methods: This single-center retrospective study evaluated 237 patients with early gastric cancer: 83 who underwent ESD using the CC group and 154 who underwent ESD using the insulated-tip knife 2 (IT2 group). Clinicopathological features and technical outcomes were compared between the 2 groups using a propensity score-matched analysis. Results: In 61 pairs of matched patients, there was no significant difference in R0 resection, perforation, or postoperative bleeding between the CC and IT2 groups. Comparisons between the 2 groups showed similar treatment outcomes for an expert endoscopist. Nevertheless, there were significant differences between the 2 groups for nonexperts in terms of self-completion (61.7 and 24.5%, respectively, p < 0.001), mean procedure times (45 and 61 min, respectively, p = 0.002), and mean numbers of intraoperative bleeding points and bleeding points requiring hemostatic forceps (3 and 0 vs. 8 and 3, respectively, p < 0.001). Conclusion: Better self-completion rates and shorter procedure times were noted for gastric ESD using the CC by nonexperts than for that using IT2, probably due to hemostatic efficacy.

1.
Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D, Hosokawa K, Shimoda T, Yoshida S: Endoscopic mucosal resection for treatment of early gastric cancer. Gut 2001; 48: 225–229.
2.
Fujishiro M, Yahagi N, Kakushima N, Kodashima S, Muraki Y, Ono S, Yamamichi N, Tateishi A, Oka M, Ogura K, Kawabe T, Ichinose M, Omata M: Outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms in 200 consecutive cases. Clin Gastroenterol Hepatol 2007; 5: 678–683.
3.
Takeuchi Y, Uedo N, Iishi H, Yamamoto S, Yamamoto S, Yamada T, Higashino K, Ishihara R, Tatsuta M, Ishiguro S: Endoscopic submucosal dissection with insulated-tip knife for large mucosal early gastric cancer: a feasibility study (with videos). Gastrointest Endosc 2007; 66: 186–193.
4.
Ueki N, Futagami S, Akimoto T, Maruki Y, Yamawaki H, Kodaka Y, Nagoya H, Shindo T, Kusunoki M, Kawagoe T, Gudis K, Miyake K, Iwakiri K: Effect of antithrombotic therapy and long endoscopic submucosal dissection procedure time on early and delayed postoperative bleeding. Digestion 2017; 96: 21–28.
5.
Sanomura Y, Oka S, Tanaka S, Yorita N, Kuroki K, Kurihara M, Mizumoto T, Yoshifuku Y, Chayama K: Taking warfarin with heparin replacement and direct oral anticoagulant is a risk factor for bleeding after endoscopic submucosal dissection for early gastric cancer. Digestion 2018; 97: 240–249.
6.
Akahoshi K, Akahane H, Murata A, Akiba H, Oya M: Endoscopic submucosal dissection using a novel grasping type scissors forceps. Endoscopy 2007; 39: 1103–1105.
7.
Akahoshi K, Honda K, Akahane H, Akiba H, Matsui N, Motomura Y, Kubokawa M, Endo S, Higuchi N, Oya M: Endoscopic submucosal dissection by using a grasping-type scissors forceps: a preliminary clinical study (with video). Gastrointest Endosc 2008; 67: 1128–1133.
8.
Akahoshi K, Akahane H: A new breakthrough: ESD using a newly developed grasping type scissor forceps for early gastrointestinal tract neoplasms. World J Gastrointest Endosc 2010; 2: 90–96.
9.
Akahoshi K, Akahane H, Motomura Y, Kubokawa M, Itaba S, Komori K, Nakama N, Oya M, Nakamura K: A new approach: endoscopic submucosal dissection using the clutch cutter® for early stage digestive tract tumors. Digestion 2012; 85: 80–84.
10.
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: Endoscopic submucosal dissection for early gastric cancer using the clutch cutter: a large single-center experience. Endosc Int Open 2015; 3: E432–E438.
11.
Yoshida N, Naito Y, Murakami T, Hirose R, Ogiso K, Inada Y, Abdul Rani R, Kishimoto M, Nakanishi M, Itoh Y: Tips for safety in endoscopic submucosal dissection for colorectal tumors. Ann Transl Med 2017; 5: 185.
12.
Nagai K, Uedo N, Yamashina T, Matsui F, Matsuura N, Ito T, Yamamoto S, Hanaoka N, Takeuchi Y, Higashino K, Ishihara R, Iishi H: A comparative study of grasping-type scissors forceps and insulated-tip knife for endoscopic submucosal dissection of early gastric cancer: a randomized controlled trial. Endosc Int Open 2016; 4:E654–E660.
13.
Yoshida N, Inada Y, Murakami T, et al: Colorectal endoscopic submucosal dissection for a lesion on the dentate line area resected with a scissor-type knife. VideoGIE 2018; 3: 223–225.
14.
Suzuki S, Gotoda T, Kobayashi Y, Kono S, Iwatsuka K, Yagi-Kuwata N, Kusano C, Fukuzawa M, Moriyasu F: Usefulness of a traction method using dental floss and a hemoclip for gastric endoscopic submucosal dissection: a propensity score matching analysis (with videos). Gastrointest Endosc 2016; 83: 337–346.
15.
Yoshida M, Takizawa K, Ono H, Igarashi K, Sugimoto S, Kawata N, Tanaka M, Kakushima N, Ito S, Imai K, Hotta K, Matsubayashi H: Efficacy of endoscopic submucosal dissection with dental floss clip traction for gastric epithelial neoplasia: a pilot study (with video). Surg Endosc 2016; 30: 3100–3106.
16.
Yoshida M, Takizawa K, Suzuki S, Koike Y, Nonaka S, Yamasaki Y, Minagawa T, Sato C, Takeuchi C, Watanabe K, Kanzaki H, Morimoto H, Yano T, Sudo K, Mori K, Gotoda T, Ono H; CONNECT-G Study Group: Conventional versus traction-assisted endoscopic submucosal dissection for gastric neoplasms: a multicenter, randomized controlled trial (with video). Gastrointest Endosc 2018; 87: 1231–1240.
17.
Japanese Gastric Cancer Association: Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 2011; 14: 101–112.
18.
Rubin DB: Estimating causal effects from large data sets using propensity scores. Ann Intern Med 1997; 127(8 Pt 2): 757–763.
19.
Toyonaga T, Nishino E, Hirooka T, et al: Intraoperative bleeding in endoscopic submucosal dissection in the stomach and strategy for prevention and treatment. Dig Endosc 2006; 18(suppl 1):S123–S127.
20.
Chung IK, Lee JH, Lee SH, et al: Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD Study Group multicenter study. Gastrointest Endosc 2009; 69: 1228–1235.
21.
Yamamoto Y, Fujisaki J, Ishiyama A, et al: Current status of training for endoscopic submucosal dissection for gastric epithelial neoplasm at cancer institute hospital, Japanese foundation for cancer research, a famous Japanese hospital. Dig Endosc 2012; 24(suppl 1): 148–153.
22.
Białek A, Wiechowska-Kozłowska A, Pertkiewicz J, Karpińska K, Marlicz W, Milkiewicz P, Starzyńska T: Endoscopic submucosal dissection for the treatment of neoplastic lesions in the gastrointestinal tract. World J Gastroenterol 2013; 19: 1953–1961.
You do not currently have access to this content.