EFFICACY AND SAFETY OF ESD USING CLUTCH CUTTER® FOR GASTROINTESTINAL SUBEPITHELIAL LESIONS

Aims:

To evaluate the efficacy and safety of ESD using Clutch Cutter® (CC) for gastrointestinal subepithelial lesion (SEL).

Methods:

Between June 2007 and March 2017, 1282 patients with early gastrointestinal neoplasms underwent single-device ESD using CC at our department. We prospectively examined the short-term outcomes of 51 of these patients (23 men and 28 women; mean age, 61 years) who were diagnosed with SEL based on post-ESD histopathological findings.

Results:

The histopathological diagnosis of the resected specimens included neuroendocrine tumors in 36 patients, germ cell tumors in six, benign lymphoid polyp in three, leiomyoma in two, and lipoma, aberrant pancreas, inflammatory fibroid polyp, and leiomyosarcoma in one each. The lesions were located in the esophagus in six patients, stomach in eight, and colon-rectum in 37. Using the CC, all ESD procedures, from marking to circumferential cutting, dissecting the submucosa, and hemostasis, were performed using just one device. We were able to isolate the target tissue using electrosurgical current by precisely grasping, confirming, and pulling the target in a manner similar to that of biopsy. Evaluation of short-term outcomes resulted in the following:

1. En bloc resection rate, 100% (50/50);

2. R0 resection rate, 90% (46/50);

3. mean tumor diameter and mean resected specimen diameters, 8.1 ± 5.2 mm and 25.4 ± 11.2 mm, respectively; and

4. mean resection time, 50.2 ± 31.3 min.

5. The only complication encountered was postoperative hemorrhage in one patient (2%), in whom hemostasis was successfully achieved endoscopically.

There were no cases of intraoperative or postoperative perforation.

Conclusions:

ESD using CC is an effective and safe therapeutic method for SEL.