1Endoscopy Center, Aso Iizuka Hospital, Iizuka, Japan
2Department of Gastroenterology, Aso Iizuka Hospital, Iizuka, Japan
3Department of Pathology, Aso Iizuka Hospital, Iizuka, Japan
4Clinical Research Support Office, Aso Iizuka Hospital, Iizuka, Japan
© 2024 Korean Society of Gastrointestinal Endoscopy
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Conflicts of Interest
Kazuya Akahoshi and Fujifilm have applied for a patent for the Clutch Cutter described in this article. Japan, China, and the EU have already granted patents. The co-authors have no potential conflicts of interest.
Funding
This research was conducted with the assistance of a research grant (AIH-CRG2021-1) from the Aso Iizuka Hospital.
Acknowledgments
We thank Phoebe Chi, MD, from Edanz (https://jp.edanz.com/ac) for editing the draft of this manuscript.
Author Contributions
Conceptualization: KazuyaA; Data curation: KazuyaA; Formal analysis: KazuyaA, HK; Funding acquisition: KazuyaA; Investigation: KazuyaA, KI, KazuakiA, SO, ST, YO, MO; Methodology: KazuyaA, KI, KazuakiA, SO, ST, YO, MO; Project administration: KazuyaA; Resources: KazuyaA; Software: KazuyaA; Supervision: KazuyaA; Validation: KazuyaA; Visualization: KazuyaA; Writing–original draft: KazuyaA; Writing–review & editing: all authors.
Study | Year | Organ | No. of lesions | Device | Procedure time (min) | En bloc resection rate (%) | R0 resection rate (%) | Delayed bleeding rate (%) | Perforation rate (%) |
---|---|---|---|---|---|---|---|---|---|
Hoteya et al.12 | 2009 | Stomach | 9 | Hook knife, Flex knife | 116.1 | 100 | 100 | 0 | 0 |
Białek et al.18 | 2012 | Stomach | 15 | Needle knife, IT-knife | ND | 100 | 100 | ND | ND |
Catalano et al.19 | 2013 | Stomach | 17 | Hook knife, IT-knife | 107.6 | 88.2 | 88.2 | 0 | 11.7 |
Kobara et al.13 | 2020 | Esophagus, stomach | 15 | Needle knife | ND | 100 | 73.3 | 13.3 | 6.7 |
Our study | 2024 | Esophagus, stomach | 18 | Clutch Cutter | 45.4 | 94.4 | 88.9 | 0 | 0 |
Patient | Age (yr)/sex | Organ/location | EUS findings of SELEGSM |
Pre-ESD-CC histological diagnosis (biopsy) | Post-ESD-CC histological diagnosis | R0 resection/additional treatment | ||
---|---|---|---|---|---|---|---|---|
Diameter (mm) | Continuity with muscularis propria | Echo level | ||||||
1 | 62/M | Esophagus/middle thoracic | 15 | No | Hypoechoic | Granular cell tumor | Granular cell tumor | Yes/none |
2 | 45/F | Esophagus/cervical | 6 | No | Hypoechoic | Granular cell tumor | Granular cell tumor | Yes/none |
3 | 53/F | Esophagus/middle thoracic | 5 | No | Hypoechoic | Granular cell tumor | Granular cell tumor | Yes/none |
4 | 51/F | Esophagus/middle thoracic | 6 | No | Hypoechoic | Granular cell tumor | Granular cell tumor | Yes/none |
5 | 40/M | Esophagus/lower thoracic | 6 | No | Hypoechoic | Granular cell tumor | Granular cell tumor | Yes/none |
6 | 42/F | Esophagus/cervical | 8 | No | Anechoic | Leiomyoma | Leiomyoma | Yes/none |
7 | 50/F | Stomach/antrum | 8 | No | Hypoechoic | Not conclusive | Ectopic pancreas | Yes/none |
8 | 59/F | Stomach/cardia | 31 | No | Hyperechoic | Well differentiated adenocarcinoma/not conclusive for SEL | 10 mm intra- mucosal adenocarcinoma on 30 mm lipoma | Yes (lipoma including intra-mucosal cancer)/none |
9 | 72/F | Stomach/body | 3 | No | Hypoechoic | Neuroendocrine tumor | Neuroendocrine tumor | Yes/none |
10 | 71/M | Stomach/antrum | 5 | No | Hypoechoic | Not conclusive | Ectopic pancreas | Yes/none |
11 | 77/F | Stomach/body | 9 | No | Hypoechoic | Neuroendocrine tumor | Neuroendocrine tumor | Yes/none |
11 | 77/F | Stomach/body | 3 | No | Hypoechoic | Neuroendocrine tumor | Neuroendocrine tumor | Yes/none |
12 | 38/F | Stomach/body | 9 | No | Hypoechoic | Not conclusive | Granular cell tumor | Discontinuance/surgery |
13 | 78/F | Stomach/antrum | 7 | No | Hypoechoic | Not conclusive | Inflammatory fibroid polyp | Yes/none |
14 | 74/F | Stomach/cardia | 12 | No | Hypoechoic | Not conclusive | Leiomyosarcoma | No/none |
15 | 46/F | Stomach/body | 4 | No | Hypoechoic | Neuroendocrine tumor | Neuroendocrine tumor | Yes/none |
15 | 46/F | Stomach/body | 5 | No | Hypoechoic | Neuroendocrine tumor | Neuroendocrine tumor | Yes/none |
15 | 46/F | Stomach/cardia | 4 | Yes | Hypoechoic | Not conclusive | Neuroendocrine tumor | Yes/none |
Overall (n=18) | Esophagus (n=6) | Stomach (n=12) | p-value (esophagus vs. stomach) | |
---|---|---|---|---|
Median diameter of the lesion (mm) | 8 [4–14] (3–31) | 10 [8–14] (4–15) | 8 [8–12.5] (3–31) | 0.480 |
Median diameter of resected specimen (mm) | 25 [18–25] (10–60) | 25 [18–25] (15–25) | 25 [17–40] (10–60) | 0.715 |
En bloc resection rate | 17 (94.4) | 6 (100.0) | 11 (91.7) | 1.00 |
R0 resection rate | 16 (88.9) | 6 (100.0) | 10 (83.3) | 0.529 |
Median operating time (min) | 39 [20–63] (15–89) | 27.5 [18–59] (15–63) | 45 [25–82] (18–89) | 0.171 |
Complication rate | 0 (0) | 0 (0) | 0 (0) | - |
Perforation rate | 0 (0) | 0 (0) | 0 (0) | - |
Intra-ESD perforation rate | 0 (0) | 0 (0) | 0 (0) | - |
Post-ESD perforation rate | 0 (0) | 0 (0) | 0 (0) | - |
Bleeding rate | 0 (0) | 0 (0) | 0 (0) | - |
Intra-ESD uncontrollable bleeding rate | 0 (0) | 0 (0) | 0 (0) | - |
Post-ESD bleeding rate | 0 (0) | 0 (0) | 0 (0) | - |
Study | Year | Organ | No. of lesions | Device | Procedure time (min) | En bloc resection rate (%) | R0 resection rate (%) | Delayed bleeding rate (%) | Perforation rate (%) |
---|---|---|---|---|---|---|---|---|---|
Hoteya et al.12 | 2009 | Stomach | 9 | Hook knife, Flex knife | 116.1 | 100 | 100 | 0 | 0 |
Białek et al.18 | 2012 | Stomach | 15 | Needle knife, IT-knife | ND | 100 | 100 | ND | ND |
Catalano et al.19 | 2013 | Stomach | 17 | Hook knife, IT-knife | 107.6 | 88.2 | 88.2 | 0 | 11.7 |
Kobara et al.13 | 2020 | Esophagus, stomach | 15 | Needle knife | ND | 100 | 73.3 | 13.3 | 6.7 |
Our study | 2024 | Esophagus, stomach | 18 | Clutch Cutter | 45.4 | 94.4 | 88.9 | 0 | 0 |
ESD-CC, endoscopic submucosal dissection using a clutch cutter; SELEGSM, subepithelial lesions within the esophagogastric submucosa; M, male; F, female; SEL, subepithelial lesion.
Values are presented as median [interquartile range] (range) or number (%). ESD, endoscopic submucosal dissection; -, incalculable.
ESD, endoscopic submucosal dissection; SELEGSM, subepithelial lesions within the esophagogastric submucosa; ND, not described.