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.

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.

Objective:To compare the clinical benefits of classic endoscopic submucosal dissection (ESD) and hybrid ESD for the treatment of colorectal epithelium-derived tumors.Methods:The current investigation was a retrospective multicenter study of 418 patients who underwent ESD between January 2015 and April 2021 at Beijing Jishuitan Hospital. The patients were assigned to one of two groups based on the surgical procedure they underwent; a classic ESD group or a hybrid ESD group. The primary outcome was the rate of en bloc resection and complete resection. SPSS 26.0 was used for statistical analysis. Homogeneity of variance was assessed via Cochran′s test. Normally distributed data with homogeneity of variance were analyzed via the t-test for independent samples. Non-normally distributed data and data with unequal variance were analyzed via the Kruskal-Wallis non-parametric test. Categorical data were analyzed via the Chi-square test or Fisher′s exact test. Multivariable assessment was performed via logistic regression analysis. Results:The en bloc resection rates [89.4% (84/94) vs. 87.0% (194/223), χ2=0.34, P=0.558] and complete resection rates [85.1% (80/94) vs. 82.1% (183/223), χ2=0.33, P=0.510] were similar. Compared with classic ESD, procedures were shorter in the hybrid ESD group [22(7, 213) vs. 47(12, 680) min, Z=0.23, P<0.001], dissection was completed more rapidly [0.14(0.02, 0.32) vs. 0.10(0.02, 0.41) cm 2/min, Z=0.08, P<0.001], and there was a higher rate of perforation (9.6% vs. 2.2%, χ2=2.67, P=0.006). Laterally spreading tumor granular type nodular mixed, non-granular type pseudo-depressed, flat-elevated type (odds ratio 2.826, P=0.012), and tumor location (odds ratio 6.970, P=0.005) were independently associated with complete resection in the hybrid ESD group. Conclusion:Classic ESD and hybrid ESD had similar en bloc and complete resection rates for colorectal epithelium-derived tumors, but hybrid ESD had shorter operation times. With respect to hybrid ESD, factors associated with failure of complete resection included lesion type and crossing tissue boundaries.