Endoscopic submucosal dissection using the “Clutch Cutter” for early esophageal squamous cell carcinoma

Background and study aims: To reduce the risk of complications related to the use of knives in endoscopic submucosal dissection (ESD), we developed the Clutch Cutter which can grasp and incise targeted tissue using electrosurgical current, similarly to a biopsy technique. The study aim was to evaluate the efficacy and safety of ESD using the Clutch Cutter for early esophageal squamous cell carcinoma.

Patients and methods: ESD using the Clutch Cutter was performed on 32 consecutive patients with early esophageal squamous cell carcinoma. Therapeutic efficacy and safety were assessed.

Results: All lesions were treated easily and safely without unintended incision. En bloc resection was obtained in all patients. Histologically negative margins were obtained in 26/32 patients (81 %). Endoscopic perforation due to the hood in one patient (3 %), mediastinitis without endoscopic perforation in one patient (3 %), and post-ESD stricture in 5 patients (16 %) were observed. All were successfully managed conservatively.

Conclusions: ESD using the Clutch Cutter appears to be a safe, easy, and technically efficient method for resecting early esophageal squamous cell carcinomas.

• References

• 1 Oyama T, Tomori A, Hotta K et al. Endoscopic submucosal dissection of early esophageal cancer. Clin Gastroenterol Hepatol 2005; 3: 67-S70
• 2 Ishihara R, Iishi H, Uedo N et al. Comparison of EMR and endoscopic submucosal dissection for en bloc resection of early esophageal cancers in Japan. Gastrointest Endosc 2008; 68: 1066-1072
• 3 Ono S, Fujishiro M, Niimi K et al. Long term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms. Gastrointest Endosc 2009; 70: 860-866
• 4 Repici A, Hassan C, Carlino A et al. Endoscopic submucosal dissection in patients with early esophageal squamous cell carcinoma: results from a prospective Western series. Gastrointest Endosc 2010; 71: 715-721
• 5 Takahashi H, Arimura Y, Hosokawa M et al. Endoscopic submucosal dissection is superior to conventional endoscopic resection as a curative treatment for early squamous cell carcinoma of the esophagus (with video). Gastrointest Endosc 2010; 72: 255-264
• 6 Akahoshi K, Honda K, Motomura Y et al. Endoscopic submucosal dissection using a grasping type scissors forceps for early gastric cancers and adenomas. Dig Endosc 2011; 23: 24-29
• 7 Akahoshi K, Okamoto R, Akahane H et al. Endoscopic submucosal dissection of early colorectal tumors using a grasping type scissors forceps: a preliminary clinical study – a case series. Endoscopy 2010; 42: 419-422
• 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 et al. A new approach: endoscopic submucosal dissection using the Clutch Cutter for early stage digestive tract tumors. Digestion 2012; 85: 80-84
• 10 Katada C, Muto M, Manabe T et al. Local recurrence of squamous-cell carcinoma of the esophagus after EMR. Gastrointest Endosc 2005; 61: 215-225
• 11 Fujishiro M, Yahagi N, Kakushima N et al. Endoscopic submucosal dissection of esophageal squamous cell neoplasms. Clin Gastroenterol Hepatol 2006; 6: 688-694
• 12 Maeda Y, Hirasawa D, Fujita N et al. Mediastinal emphysema after esophageal endoscopic submucosal dissection: its prevalence and clinical significance. Dig Endosc 2011; 23: 221-226
• 13 Nonaka K, Arai S, Ishikawa K et al. Short term results of endoscopic submucosal dissection in superficial esophageal squamous cell neoplasms. World J Gastrointest Endosc 2010; 2: 69-74
• 14 Tamiya Y, Nakahara K, Kominato K et al. Pneumo-mediastinum is a frequent but minor complication during esophageal endoscopic submucosal dissection. Endoscopy 2010; 42: 8-14
• 15 Katada C, Muto M, Manabe T et al. Esophageal stenosis after endoscopic mucosal resection of superficial esophageal lesions. Gastrointest Endosc 2003; 57: 165-169