Efficacy and safety of scissor-type knife for endoscopic submucosal dissection in patients with sessile elevated colorectal epithelium-derived tumors
10.3760/cma.j.cn321463-20241031-00497
- VernacularTitle:剪状刀内镜黏膜下剥离术治疗无蒂隆起型结直肠上皮源性肿瘤的有效性及安全性
- Author:
Yan GAO
1
;
Ye WANG
1
;
Yu LAN
1
;
Chunzeng JIA
1
Author Information
1. 首都医科大学附属北京积水潭医院消化内科，北京 100035
- Publication Type:Journal Article
- Keywords:
Colorectal neoplasms;
Sessile elevated;
Epithelium-derived;
Endoscopic submucosal dissection;
Scissor knife;
Needle knife;
Efficacy;
Safety
- From:
Chinese Journal of Digestive Endoscopy
2025;42(2):142-147
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the efficacy and safety of scissor-type knife for endoscopic submucosal dissection (ESD) in patients with sessile elevated colorectal epithelium-derived tumors.Methods:A retrospective cohort study was conducted on 127 patients who underwent ESD for sessile elevated colorectal epithelium-derived tumor at Beijing Jishuitan Hospital from January 2015 to June 2023. Patients were divided into two groups based on the electric knife type: scissor-type knife ESD group ( n=62) and needle-type knife ESD group ( n=65). Parameters evaluated included en bloc resection rate, complete resection rate, operation time, and associated complications. Results:There were no statistical differences between the two groups in terms of the median age of patients, gender, cases with a history of previous abdominal surgery, median long diameter of lesions, poor submucosal injection lifting sign, submucosal fibrosis, lesions crossing folds, depth of invasion≥1 000 μm or adenocarcinoma cases ( P>0.05). However, there were statistical differences in lesion distribution ( χ2=19.288, P<0.001) and proportion of cases crossing tortuous areas ( χ2=5.148, P=0.023). The proportion of colon cases [82.3% (51/62) VS 44.6% (29/65)] and proportion of cases crossing tortuous areas [24.2% (15/62) VS 9.2% (6/65)] were higher in the scissor knife group. In terms of surgical outcomes, the en bloc resection rate, complete resection rate and operation time in the scissor knife group were 95.2% (59/62), 91.9% (57/62), and 38.5 (24.0, 73.0) min respectively. The corresponding outcomes in the needle knife group were 89.2% (58/65) ( χ2=1.539, P=0.325), 87.7% (57/65) ( χ2=0.622, P=0.430), and 28.0 (25.0, 82.0) min ( Z=-0.912, P=0.362) respectively. Regarding surgical complications, the incidence of intraoperative refractory bleeding was significantly lower in the scissor knife group [12.9% (8/62) VS 29.2% (19/65), χ2=5.053, P=0.025], while there were no statistical differences in the incidence of intraoperative perforation, delayed bleeding, delayed perforation, electrocoagulation syndrome, or postoperative fever between the two groups ( P>0.05). Conclusion:In performing ESD for sessile elevated colorectal epithelium tumors, the use of a scissor-type knife demonstrates comparable therapeutic efficacy to the needle knife, even in cases with challenging factors like a higher proportion of colon cases and those crossing tortuous areas. Additionally, the scissor knife approach shows a lower incidence of intraoperative refractory bleeding, indicating enhanced safety during the procedure.
