World Congress of Gastroenterology

WCOG 2019


 
TECHNICAL OUTCOME BY ORGAN OF ENDOSCOPIC SUBMUCOSAL DISSECTION USING THE CLUTCH CUTTER FOR EARLY DIGESTIVE TRACT EPITHELIAL TUMORS
KAZUYA AKAHOSHI 1 MASARU KUBOKAWA 1 JYUNYA GIBO 1 YUKI SHIRATSUCHI 1 KAZUAKI AKAHOSHI 1 KENTAROU YODOE 1 KAZUKI INAMURA 1 SHIGEKI OSADA 1 TOSHIYUKI ABE 1 YUSUKE KIMURA 1

1- ASO IIZUKA HOSPITAL
 
Background/Aims:

 There are few reports comparing the technical results of endoscopic submucosal dissection (ESD) using the Clutch Cutter for early digestive tract epithelial tumors by organ. The aim of this study is to clarify the procedure results of ESD using the Clutch Cutter for early digestive tract epithelial tumors by organ.

Materials and Methods:

 From June 2007 to December 2018, 1515 consecutive patients (991 men, 524 women; mean age 71 years, range 35-95) with a diagnosis of early digestive tract epithelial tumor (adenoma, intramucosal, or superficial submucosal cancer without lymph node involvement) that had been confirmed by preliminary endoscopy, EUS, and endoscopic biopsies, were enrolled into this prospective study. The Clutch Cutter was used for all steps of ESD (marking, mucosal incision, submucosal dissection, and hemostatic treatment). Therapeutic efficacy and safety were assessed by organ.

Results:

The number of cases by organ was 125 in the esophagus, 875 in the stomach, 15 in the duodenum, 2 in the small intestine, and 498 in the colon and rectum. Overall R0 resection rate, perforation rate, post ESD bleeding rate, and mean operating time were 92%, 1%, 3%, and 89 minutes, respectively. The R0 resection rate was 87% in the esophagus, 96% in the stomach, 67% in the duodenum, 50% in the small intestine, and 86% in the colon and rectum. The perforation rate was 0.8% in the esophagus, 0.1% in the stomach, 7% in the duodenum, 0% in the small intestine, and 2% in the colon and rectum. The post-ESD bleeding rate was 0.8% in the esophagus, 3% in the stomach, 0% in the duodenum, 0% in the small intestine, and 3% in the colon and rectum. The mean operating time was 71 minutes for the esophagus, 93 minutes for the stomach, 110 minutes for the duodenum, 35 minutes for the small intestine, and 87 minutes for the colon and rectum.
 

Conclusion:

 ESD using the Clutch Cutter is a safe and technically efficient method for resecting early digestive tract epithelial tumors of all organs.

Keywords:

Early digestive tract epithelial tumor, ESD, Clutch Cutter