Scissor‐type knife significantly improves self‐completion rate of colorectal endoscopic submucosal dissection: Single‐center prospective randomized trial. Issue 3 (20th January 2017)

• Record Type: Journal Article
• Authors: Yamashina, Takeshi; Takeuchi, Yoji; Nagai, Kengo; Matsuura, Noriko; Ito, Takashi; Fujii, Mototsugu; Hanaoka, Noboru; Higashino, Koji; Uedo, Noriya; Ishihara, Ryu; Iishi, Hiroyasu
• Is Part Of: Digestive endoscopy. Volume 29:Issue 3(2017)
• Page Start: 322
• Page End: 329
• Publication Date: 2017-01-20
• Subjects: colonic neoplasm -- colonoscopy -- endoscopic submucosal dissection (ESD) -- medical device -- randomized controlled trial; Digestive organs -- Diseases -- Periodicals; Digestive organs -- Diseases -- Diagnosis -- Periodicals; Endoscopy -- Periodicals; Digestive System Diseases -- diagnosis -- Periodicals; Digestive System Diseases -- therapy -- Periodicals; Endoscopy -- Periodicals; 616.3
• DOI: 10.1111/den.12784
• Languages: English
• ISSNs: 0915-5635

Abstract

Abstract : Background and Aim: Colorectal endoscopic submucosal dissection (C‐ESD) is recognized as a difficult procedure. Recently, scissors‐type knives were launched to reduce the difficulty of C‐ESD. The aim of this study was to evaluate the efficacy and safety of the combined use of a scissors‐type knife and a needle‐type knife with a water‐jet function (WJ needle‐knife) for C‐ESD compared with using the WJ needle‐knife alone. Methods: This was a prospective randomized controlled trial in a referral center. Eighty‐five patients with superficial colorectal neoplasms were enrolled and randomly assigned to undergo C‐ESD using a WJ needle‐knife alone (Flush group) or a scissor‐type knife‐supported WJ needle‐knife (SB Jr group). Procedures were conducted by two supervised residents. Primary endpoint was self‐completion rate by the residents. Results: Self‐completion rate was 67% in the SB Jr group, which was significantly higher than that in the Flush group (39%, P = 0.01). Even after exclusion of four patients in the SB Jr group in whom C‐ESD was completed using the WJ needle‐knife alone, the self‐completion rate was significantly higher (63% vs 39%; P = 0.03). Median procedure time among the self‐completion cases did not differ significantly between the two groups (59 vs 51 min; P = 0.14). No fatal adverse events were observed in either group. Conclusions: In this single‐center phase II trial, scissor‐type knife significantly improved residents' self‐completion rate for C‐ESD, with no increase in procedure time or adverse events. A multicenter trial would be warranted to confirm the validity of the present study.