Efficacy of Clutch Cutter for Standardizing Endoscopic Submucosal Dissection for Early Gastric Cancer: A Propensity Score-Matched Analysis
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 evalu...
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| Veröffentlicht in: | Digestion 2019-10, Vol.100 (3), p.201-209 |
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| creator | Dohi, Osamu Yoshida, Naohisa Terasaki, Kei Azuma, Yuka Ishida, Tsugitaka Kitae, Hiroaki Matsumura, Shinya Ogita, Kazuyuki Takayama, Shun Mizuno, Naoki Nakano, Takahiro Hirose, Ryohei Inoue, Ken Kamada, Kazuhiro Uchiyama, Kazuhiko Ishikawa, Takeshi Takagi, Tomohisa Kishimoto, Mitsuo Konishi, Hideyuki Naito, Yuji Itoh, Yoshito |
| description | 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. |
| doi_str_mv | 10.1159/000495287 |
| format | Article |
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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.</description><identifier>ISSN: 0012-2823</identifier><identifier>EISSN: 1421-9867</identifier><identifier>DOI: 10.1159/000495287</identifier><identifier>PMID: 30522097</identifier><language>eng</language><publisher>Basel, Switzerland</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Blood Loss, Surgical - statistics & numerical data ; Electrocoagulation - adverse effects ; Electrocoagulation - instrumentation ; Electrocoagulation - methods ; Endoscopic Mucosal Resection - adverse effects ; Endoscopic Mucosal Resection - instrumentation ; Endoscopic Mucosal Resection - methods ; Female ; Gastric Mucosa - injuries ; Gastric Mucosa - pathology ; Gastric Mucosa - surgery ; Gastroscopy - adverse effects ; Gastroscopy - instrumentation ; Gastroscopy - methods ; Humans ; Male ; Middle Aged ; Operative Time ; Original Paper ; Postoperative Hemorrhage - epidemiology ; Postoperative Hemorrhage - etiology ; Propensity Score ; Retrospective Studies ; Stomach Neoplasms - pathology ; Stomach Neoplasms - surgery ; Treatment Outcome</subject><ispartof>Digestion, 2019-10, Vol.100 (3), p.201-209</ispartof><rights>2018 S. Karger AG, Basel</rights><rights>2018 S. Karger AG, Basel.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c400t-50cfc32e9d544d474533b83ee363ea4a351d6f9133acf66e43778ecd43cb510b3</citedby><orcidid>0000-0002-7103-8191 ; 0000-0001-8964-8396</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,2424,27906,27907</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30522097$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dohi, Osamu</creatorcontrib><creatorcontrib>Yoshida, Naohisa</creatorcontrib><creatorcontrib>Terasaki, Kei</creatorcontrib><creatorcontrib>Azuma, Yuka</creatorcontrib><creatorcontrib>Ishida, Tsugitaka</creatorcontrib><creatorcontrib>Kitae, Hiroaki</creatorcontrib><creatorcontrib>Matsumura, Shinya</creatorcontrib><creatorcontrib>Ogita, Kazuyuki</creatorcontrib><creatorcontrib>Takayama, Shun</creatorcontrib><creatorcontrib>Mizuno, Naoki</creatorcontrib><creatorcontrib>Nakano, Takahiro</creatorcontrib><creatorcontrib>Hirose, Ryohei</creatorcontrib><creatorcontrib>Inoue, Ken</creatorcontrib><creatorcontrib>Kamada, Kazuhiro</creatorcontrib><creatorcontrib>Uchiyama, Kazuhiko</creatorcontrib><creatorcontrib>Ishikawa, Takeshi</creatorcontrib><creatorcontrib>Takagi, Tomohisa</creatorcontrib><creatorcontrib>Kishimoto, Mitsuo</creatorcontrib><creatorcontrib>Konishi, Hideyuki</creatorcontrib><creatorcontrib>Naito, Yuji</creatorcontrib><creatorcontrib>Itoh, Yoshito</creatorcontrib><title>Efficacy of Clutch Cutter for Standardizing Endoscopic Submucosal Dissection for Early Gastric Cancer: A Propensity Score-Matched Analysis</title><title>Digestion</title><addtitle>Digestion</addtitle><description>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.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Blood Loss, Surgical - statistics & numerical data</subject><subject>Electrocoagulation - adverse effects</subject><subject>Electrocoagulation - instrumentation</subject><subject>Electrocoagulation - methods</subject><subject>Endoscopic Mucosal Resection - adverse effects</subject><subject>Endoscopic Mucosal Resection - instrumentation</subject><subject>Endoscopic Mucosal Resection - methods</subject><subject>Female</subject><subject>Gastric Mucosa - injuries</subject><subject>Gastric Mucosa - pathology</subject><subject>Gastric Mucosa - surgery</subject><subject>Gastroscopy - adverse effects</subject><subject>Gastroscopy - instrumentation</subject><subject>Gastroscopy - methods</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Operative Time</subject><subject>Original Paper</subject><subject>Postoperative Hemorrhage - epidemiology</subject><subject>Postoperative Hemorrhage - etiology</subject><subject>Propensity Score</subject><subject>Retrospective Studies</subject><subject>Stomach Neoplasms - pathology</subject><subject>Stomach Neoplasms - surgery</subject><subject>Treatment Outcome</subject><issn>0012-2823</issn><issn>1421-9867</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNptkE1v1DAQhq0K1C5LD70jZKkXOAT8la_eVumyVCoCaeEcecfj4jYbp7ZzCD-BX03Klj1xGo3med-RHkIuOPvAeV5_ZIypOhdVeUIWXAme1VVRviALxrjIRCXkGXkV4_3TWit5Ss4ky4Vgdbkgv9fWOtAwUW9p040JftJmTAkDtT7QbdK90cG4X66_o-ve-Ah-cEC3424_go-6o9cuRoTkfP83stahm-hGxxRmrtE9YLiiK_ot-AH76NJEt-ADZl_0_AwNXfW6m6KLr8lLq7uI589zSX58Wn9vPme3Xzc3zeo2A8VYynIGFqTA2uRKGVWqXMpdJRFlIVErLXNuCltzKTXYokAly7JCMErCLudsJ5fk3aF3CP5xxJjavYuAXad79GNsBS9rIUU5q1qS9wcUgo8xoG2H4PY6TC1n7ZP69qh-Zt8-185q0BzJf65n4M0BeNDhDsMROOYv_3u-vtkciHYwVv4BfYiUaA</recordid><startdate>20191001</startdate><enddate>20191001</enddate><creator>Dohi, Osamu</creator><creator>Yoshida, Naohisa</creator><creator>Terasaki, Kei</creator><creator>Azuma, Yuka</creator><creator>Ishida, Tsugitaka</creator><creator>Kitae, Hiroaki</creator><creator>Matsumura, Shinya</creator><creator>Ogita, Kazuyuki</creator><creator>Takayama, Shun</creator><creator>Mizuno, Naoki</creator><creator>Nakano, Takahiro</creator><creator>Hirose, Ryohei</creator><creator>Inoue, Ken</creator><creator>Kamada, Kazuhiro</creator><creator>Uchiyama, Kazuhiko</creator><creator>Ishikawa, Takeshi</creator><creator>Takagi, Tomohisa</creator><creator>Kishimoto, Mitsuo</creator><creator>Konishi, Hideyuki</creator><creator>Naito, Yuji</creator><creator>Itoh, Yoshito</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7103-8191</orcidid><orcidid>https://orcid.org/0000-0001-8964-8396</orcidid></search><sort><creationdate>20191001</creationdate><title>Efficacy of Clutch Cutter for Standardizing Endoscopic Submucosal Dissection for Early Gastric Cancer: A Propensity Score-Matched Analysis</title><author>Dohi, Osamu ; Yoshida, Naohisa ; Terasaki, Kei ; Azuma, Yuka ; Ishida, Tsugitaka ; Kitae, Hiroaki ; Matsumura, Shinya ; Ogita, Kazuyuki ; Takayama, Shun ; Mizuno, Naoki ; Nakano, Takahiro ; Hirose, Ryohei ; Inoue, Ken ; Kamada, Kazuhiro ; Uchiyama, Kazuhiko ; Ishikawa, Takeshi ; Takagi, Tomohisa ; Kishimoto, Mitsuo ; Konishi, Hideyuki ; Naito, Yuji ; Itoh, Yoshito</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c400t-50cfc32e9d544d474533b83ee363ea4a351d6f9133acf66e43778ecd43cb510b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Blood Loss, Surgical - statistics & numerical data</topic><topic>Electrocoagulation - adverse effects</topic><topic>Electrocoagulation - instrumentation</topic><topic>Electrocoagulation - methods</topic><topic>Endoscopic Mucosal Resection - adverse effects</topic><topic>Endoscopic Mucosal Resection - instrumentation</topic><topic>Endoscopic Mucosal Resection - methods</topic><topic>Female</topic><topic>Gastric Mucosa - injuries</topic><topic>Gastric Mucosa - pathology</topic><topic>Gastric Mucosa - surgery</topic><topic>Gastroscopy - adverse effects</topic><topic>Gastroscopy - instrumentation</topic><topic>Gastroscopy - methods</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Operative Time</topic><topic>Original Paper</topic><topic>Postoperative Hemorrhage - epidemiology</topic><topic>Postoperative Hemorrhage - etiology</topic><topic>Propensity Score</topic><topic>Retrospective Studies</topic><topic>Stomach Neoplasms - pathology</topic><topic>Stomach Neoplasms - surgery</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dohi, Osamu</creatorcontrib><creatorcontrib>Yoshida, Naohisa</creatorcontrib><creatorcontrib>Terasaki, Kei</creatorcontrib><creatorcontrib>Azuma, Yuka</creatorcontrib><creatorcontrib>Ishida, Tsugitaka</creatorcontrib><creatorcontrib>Kitae, Hiroaki</creatorcontrib><creatorcontrib>Matsumura, Shinya</creatorcontrib><creatorcontrib>Ogita, Kazuyuki</creatorcontrib><creatorcontrib>Takayama, Shun</creatorcontrib><creatorcontrib>Mizuno, Naoki</creatorcontrib><creatorcontrib>Nakano, Takahiro</creatorcontrib><creatorcontrib>Hirose, Ryohei</creatorcontrib><creatorcontrib>Inoue, Ken</creatorcontrib><creatorcontrib>Kamada, Kazuhiro</creatorcontrib><creatorcontrib>Uchiyama, Kazuhiko</creatorcontrib><creatorcontrib>Ishikawa, Takeshi</creatorcontrib><creatorcontrib>Takagi, Tomohisa</creatorcontrib><creatorcontrib>Kishimoto, Mitsuo</creatorcontrib><creatorcontrib>Konishi, Hideyuki</creatorcontrib><creatorcontrib>Naito, Yuji</creatorcontrib><creatorcontrib>Itoh, Yoshito</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Digestion</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dohi, Osamu</au><au>Yoshida, Naohisa</au><au>Terasaki, Kei</au><au>Azuma, Yuka</au><au>Ishida, Tsugitaka</au><au>Kitae, Hiroaki</au><au>Matsumura, Shinya</au><au>Ogita, Kazuyuki</au><au>Takayama, Shun</au><au>Mizuno, Naoki</au><au>Nakano, Takahiro</au><au>Hirose, Ryohei</au><au>Inoue, Ken</au><au>Kamada, Kazuhiro</au><au>Uchiyama, Kazuhiko</au><au>Ishikawa, Takeshi</au><au>Takagi, Tomohisa</au><au>Kishimoto, Mitsuo</au><au>Konishi, Hideyuki</au><au>Naito, Yuji</au><au>Itoh, Yoshito</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Efficacy of Clutch Cutter for Standardizing Endoscopic Submucosal Dissection for Early Gastric Cancer: A Propensity Score-Matched Analysis</atitle><jtitle>Digestion</jtitle><addtitle>Digestion</addtitle><date>2019-10-01</date><risdate>2019</risdate><volume>100</volume><issue>3</issue><spage>201</spage><epage>209</epage><pages>201-209</pages><issn>0012-2823</issn><eissn>1421-9867</eissn><abstract>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.</abstract><cop>Basel, Switzerland</cop><pmid>30522097</pmid><doi>10.1159/000495287</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-7103-8191</orcidid><orcidid>https://orcid.org/0000-0001-8964-8396</orcidid></addata></record> |
| fulltext | fulltext |
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| ispartof | Digestion, 2019-10, Vol.100 (3), p.201-209 |
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| language | eng |
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| source | MEDLINE; Karger Journals |
| subjects | Adult Aged Aged, 80 and over Blood Loss, Surgical - statistics & numerical data Electrocoagulation - adverse effects Electrocoagulation - instrumentation Electrocoagulation - methods Endoscopic Mucosal Resection - adverse effects Endoscopic Mucosal Resection - instrumentation Endoscopic Mucosal Resection - methods Female Gastric Mucosa - injuries Gastric Mucosa - pathology Gastric Mucosa - surgery Gastroscopy - adverse effects Gastroscopy - instrumentation Gastroscopy - methods Humans Male Middle Aged Operative Time Original Paper Postoperative Hemorrhage - epidemiology Postoperative Hemorrhage - etiology Propensity Score Retrospective Studies Stomach Neoplasms - pathology Stomach Neoplasms - surgery Treatment Outcome |
| title | Efficacy of Clutch Cutter for Standardizing Endoscopic Submucosal Dissection for Early Gastric Cancer: A Propensity Score-Matched Analysis |
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