Endosc Int Open 2015; 03(05): E432-E438
DOI: 10.1055/s-0034-1392509
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic Submucosal Dissection for Early Gastric Cancer using the Clutch Cutter: a large single-center experience

Kazuya Akahoshi
1  Department of Gastroenterology, Aso Iizuka Hospital, Iizuka, 820-8505 Japan
,
Yasuaki Motomura
1  Department of Gastroenterology, Aso Iizuka Hospital, Iizuka, 820-8505 Japan
,
Masaru Kubokawa
1  Department of Gastroenterology, Aso Iizuka Hospital, Iizuka, 820-8505 Japan
,
Junya Gibo
1  Department of Gastroenterology, Aso Iizuka Hospital, Iizuka, 820-8505 Japan
,
Nobukatsu Kinoshita
1  Department of Gastroenterology, Aso Iizuka Hospital, Iizuka, 820-8505 Japan
,
Shigeki Osada
1  Department of Gastroenterology, Aso Iizuka Hospital, Iizuka, 820-8505 Japan
,
Kayo Tokumaru
1  Department of Gastroenterology, Aso Iizuka Hospital, Iizuka, 820-8505 Japan
,
Taizou Hosokawa
1  Department of Gastroenterology, Aso Iizuka Hospital, Iizuka, 820-8505 Japan
,
Naru Tomoeda
1  Department of Gastroenterology, Aso Iizuka Hospital, Iizuka, 820-8505 Japan
,
Yoshihiro Otsuka
1  Department of Gastroenterology, Aso Iizuka Hospital, Iizuka, 820-8505 Japan
,
Mie Matsuo
1  Department of Gastroenterology, Aso Iizuka Hospital, Iizuka, 820-8505 Japan
,
Masafumi Oya
2  Department of Pathology, Aso Iizuka Hospital, Iizuka, 820-8505 Japan
,
Hidenobu Koga
3  Clinical Research Support Office, Aso Iizuka Hospital, Iizuka, 820-8505 Japan
,
Kazuhiko Nakamura
4  Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
› Author Affiliations
Further Information

Publication History

Publication Date:
19 August 2015 (online)

  

Background and study aims: The Clutch Cutter (CC) was developed to reduce the risk of complications related to endoscopic submucosal dissection (ESD) using knives. The CC is able to grasp and coagulate and/or incise the targeted tissue using electrosurgical current, like a biopsy technique. The aim of this study was to evaluate the efficacy and safety of ESD using the CC (ESD-CC) for early gastric cancer (EGC).

Patients and methods: From June 2007 to March 2014, 325 consecutive patients with a diagnosis of EGC were enrolled in this prospective study. They had all satisfied the Japanese gastric cancer treatment guidelines for ESD indication, namely confirmation by preliminary endoscopy, endoscopic ultrasound, and endoscopic biopsies. The CC was used for all steps of ESD (marking, circumferential marginal incision, submucosal dissection, and hemostatic treatment). The therapeutic efficacy and safety were assessed.

Results: The en-bloc resection rate was 99.7 % (324/325) and the R0 resection rate was 95.3 % (310/325). The mean operating time was 97.2 minutes. Perforation during ESD-CC occurred in one case (0.3 %), which was managed with conservative medical treatment after endoscopic closure of the perforation. Post-ESD-CC bleeding occurred in 11 cases (3.4 %), which were successfully treated by endoscopic hemostatic treatment. The R0 resection rate was significantly low in tumors > 20 mm (88.9 %), and in the exclusion indication group (73.7 %). Significant differences were seen in the mean operating time, depending upon tumor size, histologic type, location, and indication criteria.

Conclusions: ESD-CC is a technically efficient, safe, and easy method for resecting EGC.