The usefulness of combining the pocket-creation method with a traction device using a scissor-type knife for colorectal endoscopic submucosal dissection

Yuri Tomita; Naohisa Yoshida; Ken Inoue; Hikaru Hashimoto; Satoshi Sugino; Ritsu Yasuda; Ryohei Hirose; Osamu Dohi; Yuji Naito; Takaaki Murakami; Yutaka Inada; Yukiko Morinaga; Mitsuo Kishimoto; Yoshito Itoh

doi:10.1007/s12664-021-01222-3

The usefulness of combining the pocket-creation method with a traction device using a scissor-type knife for colorectal endoscopic submucosal dissection

Indian J Gastroenterol. 2022 Apr;41(2):149-159. doi: 10.1007/s12664-021-01222-3. Epub 2022 Feb 24.

Authors

Affiliations

¹ Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
² Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan. naohisa@koto.kpu-m.ac.jp.
³ Department of Gastroenterology, Aiseikai Yamashina Hospital, Kyoto, Japan.
⁴ Department of Gastroenterology, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto, Japan.
⁵ Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.

PMID: 35201600
DOI: 10.1007/s12664-021-01222-3

Abstract

Introduction: Technical issues and long procedure time still remain a concern in colorectal endoscopic submucosal dissection (ESD). We examined the usefulness of combining the pocket-creation method (PCM) with a traction device (S-O clip; SO) using a scissor-type knife (Clutch Cutter 3.5 mm; CC) for decreasing ESD procedure time.

Methods: We retrospectively analyzed 95 ESD cases of PCM + SO + CC managed from August 2017 to April 2020 and 103 cases of PCM + CC treated from July 2016 to July 2017. We compared these two groups through propensity score matching. The main outcome was the analysis of the ESD procedure times under various conditions in each group.

Results: After matching, 52 cases in the PCM + SO + CC and PCM + CC groups were analyzed. The PCM + SO + CC group showed a significantly shorter ESD procedure time than the PCM + CC group (57.8 ± 31.4 vs. 81.7 ± 33.5 min, p < 0.01). Additionally, the ESD procedure time was significantly shorter in the PCM + SO + CC group than in the PCM + CC group: tumor size (tumor size < 40 mm: 45.6 ± 15.8 vs. 72.7 ± 22.9 min, p < 0.01; tumor size ≥ 40 mm: 83.1 ± 40.1 vs. 111.8 ± 45.3 min, p = 0.04), tumor location (right side: 64.7 ± 33.3 vs. 81.0 ± 29.7 min, p = 0.03; left side: 50.5 ± 28.0 vs. 82.3 ± 36.9 min, p < 0.01), tumor morphology (polypoid: 39.2 ± 18.6 vs. 74.7 ± 28.6 min, p < 0.01; nonpolypoid: 62.3 ± 32.3 vs. 84.5 ± 35.2 min, p < 0.01), endoscopist (expert: 67.3 ± 41.2 vs. 91.9 ± 40.2 min, p = 0.02; nonexpert: 50.4 ± 18.3 vs. 73.6 ± 24.9 min, p < 0.01), and fibrosis (severe fibrosis: 82.0 ± 20.5 vs. 99.8 ± 40.4 min, p = 0.169; non-severe fibrosis: 52.1 ± 23.8 vs. 75.6 ± 29.0 min, p < 0.01).

Conclusions: The combination of the PCM and SO using CC achieved a reduction in the colorectal ESD procedure time.

Keywords: Clutch Cutter; Colorectal cancers; Colorectal polyps; Colorectal tumors; Endoscopic resection; Endoscopic submucosal dissection; Endoscopic treatment; Scissor-type knife; Severe fibrosis; S–O clip; Traction device.

MeSH terms

Colorectal Neoplasms* / surgery
Endoscopic Mucosal Resection* / methods
Fibrosis
Humans
Retrospective Studies
Traction
Treatment Outcome