Two electrosurgical endo-knives for endoscopic submucosal dissection of colorectal superficial neoplasms: a prospective randomized study

Abstract

Background and study aims Few studies have directly compared endo-knives for endoscopic submucosal dissection (ESD) in humans. We compared the performances of the Mucosectom2 and SB knife Jr.

Patients and methods Two trainee endoscopists performed ESD of 36 lesions in this prospective, randomized controlled trial. Mucosal incision with a 1.5-mm Dual knife and submucosal dissection using the Mucosectom2 were performed in 1 group. Mucosal incision with a 1.5-mm Dual knife and submucosal dissection with a SB knife Jr. were performed in the other group. The primary outcome was the ESD procedure time. Secondary outcomes were total procedure time, self-completion rates, and adverse events.

Results ESD time in Mucosectom2 patients was not significantly shorter than in SB knife Jr. patients (57 ± 32 min vs. 61 ± 44 min, respectively; P = 0.94). Total procedure time in Mucosectom2 patients was not significantly shorter than in SB knife Jr. patients (81 ± 42 min vs. 82 ± 51 min, respectively; P = 0.85). The trainee self-completion rate was slightly higher in SB knife Jr. patients than in Mucosectom2 patients, although the difference was not significant (94 % vs. 100 %, respectively; P = 0.959). Fewer hemostatic procedures using the Coagrasper were performed in Mucosectom2 patients than in SB knife Jr. patients, although the difference was not significant (0.62 vs. 0.7, respectively; P = 0.432).

Conclusions Mucosectom2 and SB knife Jr. did not significantly differ in performance for colorectal ESD to safely and reliably enhance ESD. Knife selection is not as important for learning colorectal ESD as patient- and lesion-related factors.

• References

• 1 Isomoto H, Shikuwa S, Yamaguchi N. et al. Endoscopic sub-mucosal dissection for early gastric cancer: a large-scale feasibility study. Gut 2009; 58: 331-336
• 2 Soetikno RM, Gotoda T, Nakanishi Y. et al. Endoscopic mucosal resection. Gastrointest Endosc 2003; 57: 567-579
• 3 Saito Y, Uraoka T, Matsuda T. et al. Endoscopic treatment of large superficial colorectal tumors: a case series of 200 endoscopic submucosal dissections. Gastrointest Endosc 2007; 66: 966-973
• 4 Zhou PH, Yao LQ, Qin XY. Endoscopic submucosal dissection for colorectal epithelial neoplasm. Surg Endosc 2009; 23: 1546-1551
• 5 Niimi K, Fujishiro M, Kodashima S. et al. Long-term outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms. Endoscopy 2010; 42: 723-729
• 6 Toyonaga T, Mani M, East JE. et al. Endoscopic submucosal dissection cases in the esophagus, stomach, and colorectum: complication rates and long-term outcomes. Surg Endosc 2013; 27: 1000-1008
• 7 Kawahara Y, Takenaka R, Okada H. Risk management to prevent perforation during endoscopic submucosal dissection. Dig Endosc 2007; 19: 9-13
• 8 Okamoto K, Kitamura S, Muguruma N. et al. Mucosectom2-short blade for safe and efficient endoscopic submucosal dissection of colorectal tumors. Endoscopy 2013; 45: 928-930
• 9 Homma K, Otaki Y, Sugawara M. et al. Efficacy of novel SB knife Jr. examined in a multicenter study on colorectal endoscopic submucosal dissection. Dig Endosc 2012; 24: 117-120
• 10 Kanzaki H, Ishihara R, Ohta T. Randomized study of two endo-knives for endoscopic submucosal dissection of esophageal cancer. Am J Gastroenterol 2013; 108: 1293-1298
• 11 Kim ES, Cho KBM, Park KS. et al. Factors predictive of perforation during endoscopic submucosal dissection for the treatment of colorectal tumors. Endoscopy 2011; 43: 573-578
• 12 Isomoto H, Nishiyama H, Yamaguchi N. et al. Clinicopathological factors associated with clinical outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms. Endoscopy 2009; 41: 679-683
• 13 Hori K, Uraoka T, Harada K. et al. Predictive factors for technically difficult endoscopic submucosal dissection in the colorectum. Endoscopy 2014; 46: 862-870