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

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 - Endosc Int Open (2015)

Bottom Line: The therapeutic efficacy and safety were assessed.The R0 resection rate was significantly low in tumors > 20 mm (88.9 %), and in the exclusion indication group (73.7 %).ESD-CC is a technically efficient, safe, and easy method for resecting EGC.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Aso Iizuka Hospital, Iizuka, 820-8505 Japan.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus

 Basic technique of the Clutch Cutter ESD. Step 1 (Accurate targetting): The target tissue is accurately grasped by the CC. Step 2 (Leaving from the proper muscle layer): The grasped tissue is pulled (or lifted up) to avoid electrical damage to the proper muscle layer. Step 3 (Pre-cut coagulation): The grasped tissue including the blood vessel is coagulated for prevention of intraoperative bleeding. Step 4 (Cut): The grasped tissue is cut using electrosurgical current for the incision. Arrow: Direction of pull, m: mucosa, sm: submucosa, mp: muscularis propria, has: hyaluronic acid solution, bv: blood vessel.
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FI221-3:  Basic technique of the Clutch Cutter ESD. Step 1 (Accurate targetting): The target tissue is accurately grasped by the CC. Step 2 (Leaving from the proper muscle layer): The grasped tissue is pulled (or lifted up) to avoid electrical damage to the proper muscle layer. Step 3 (Pre-cut coagulation): The grasped tissue including the blood vessel is coagulated for prevention of intraoperative bleeding. Step 4 (Cut): The grasped tissue is cut using electrosurgical current for the incision. Arrow: Direction of pull, m: mucosa, sm: submucosa, mp: muscularis propria, has: hyaluronic acid solution, bv: blood vessel.

Mentions: ESD was performed by two endoscopists (one endoscopist maneuvered the scope and the other endoscopist maneuvered the CC.). ESD-CC was carried out using a single-channel therapeutic endoscope (EG-450RD5, Fujifilm) or a two-channel multi-bending endoscope (GIF-2T240M; Olympus, Tokyo, Japan). A long transparent hood (F-01, Top Co. Ltd., Tokyo, Japan) was attached to the endoscopic tip to facilitate submucosal dissection by elevating the lesion. The ESD-CC technique was as follows (Fig. 2) (VTR. 1). Marking dots were placed a few millimeters outside the margin of the lesion by CC in closed mode. Next, hyaluronic acid solution (MucoUp: Johnson and Johnson Co., Tokyo, Japan) mixed with a small volume of epinephrine and indigo carmine dye was injected into the submucosal layer. A mucosal incision and submucosal dissection were performed to completely remove the lesion using the CC. The bleeding vessel (artery or vein) was grasped, pulled/lifted and coagulated with the CC using electrosurgical current to stop the bleeding. Finally, the lesion was completely resected. All cutting steps consisted of 1) grasping step; 2) pull or lift up step; 3) pre-cut coagulation step with soft coagulation (if existence of blood vessel was suspected); and 4) cutting step with endo cut Q (Fig. 3).


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

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 - Endosc Int Open (2015)

 Basic technique of the Clutch Cutter ESD. Step 1 (Accurate targetting): The target tissue is accurately grasped by the CC. Step 2 (Leaving from the proper muscle layer): The grasped tissue is pulled (or lifted up) to avoid electrical damage to the proper muscle layer. Step 3 (Pre-cut coagulation): The grasped tissue including the blood vessel is coagulated for prevention of intraoperative bleeding. Step 4 (Cut): The grasped tissue is cut using electrosurgical current for the incision. Arrow: Direction of pull, m: mucosa, sm: submucosa, mp: muscularis propria, has: hyaluronic acid solution, bv: blood vessel.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4612246&req=5

FI221-3:  Basic technique of the Clutch Cutter ESD. Step 1 (Accurate targetting): The target tissue is accurately grasped by the CC. Step 2 (Leaving from the proper muscle layer): The grasped tissue is pulled (or lifted up) to avoid electrical damage to the proper muscle layer. Step 3 (Pre-cut coagulation): The grasped tissue including the blood vessel is coagulated for prevention of intraoperative bleeding. Step 4 (Cut): The grasped tissue is cut using electrosurgical current for the incision. Arrow: Direction of pull, m: mucosa, sm: submucosa, mp: muscularis propria, has: hyaluronic acid solution, bv: blood vessel.
Mentions: ESD was performed by two endoscopists (one endoscopist maneuvered the scope and the other endoscopist maneuvered the CC.). ESD-CC was carried out using a single-channel therapeutic endoscope (EG-450RD5, Fujifilm) or a two-channel multi-bending endoscope (GIF-2T240M; Olympus, Tokyo, Japan). A long transparent hood (F-01, Top Co. Ltd., Tokyo, Japan) was attached to the endoscopic tip to facilitate submucosal dissection by elevating the lesion. The ESD-CC technique was as follows (Fig. 2) (VTR. 1). Marking dots were placed a few millimeters outside the margin of the lesion by CC in closed mode. Next, hyaluronic acid solution (MucoUp: Johnson and Johnson Co., Tokyo, Japan) mixed with a small volume of epinephrine and indigo carmine dye was injected into the submucosal layer. A mucosal incision and submucosal dissection were performed to completely remove the lesion using the CC. The bleeding vessel (artery or vein) was grasped, pulled/lifted and coagulated with the CC using electrosurgical current to stop the bleeding. Finally, the lesion was completely resected. All cutting steps consisted of 1) grasping step; 2) pull or lift up step; 3) pre-cut coagulation step with soft coagulation (if existence of blood vessel was suspected); and 4) cutting step with endo cut Q (Fig. 3).

Bottom Line: The therapeutic efficacy and safety were assessed.The R0 resection rate was significantly low in tumors > 20 mm (88.9 %), and in the exclusion indication group (73.7 %).ESD-CC is a technically efficient, safe, and easy method for resecting EGC.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Aso Iizuka Hospital, Iizuka, 820-8505 Japan.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus