Feasibility of Knife-Coagulated Cut in Gastric Endoscopic Submucosal Dissection: A Case-Control Study.

Background/Aims: Intraoperative bleeding remains a challenge during endoscopic submucosal dissection (ESD). Forceps-coagulated cut (FCC) was found to be effective to reduce this bleeding. However, this involved frequent device replacement, and therefore, knife-coagulated cut (KCC) might ensure an easier and smoother procedure. We aimed to assess the effectiveness of KCC with Flushknife-BT at a super-low-output setting. Methods: In this prospective study, we compared the hemostasis condition during ESD in 40 pairs of gastric lesions treated by FCC (Group F) or KCC (Group K). The primary outcome was frequency of major bleeding with an analysis by tumor location. The secondary outcomes included frequency of exchanging devices, procedure time, en bloc resection rate, and adverse event rate. Results: In terms of the frequency of major bleeding, there was no significant difference between Group F and K (0.95 ± 0.12 vs. 0.88 ± 0.17, p = 0.282). Lesions located on the upper third of the stomach involved repeated hemostasis (p = 0.012). The frequency of exchanging devices was higher in Group F than in Group K (6.95 ± 0.42 vs. 0.88 ± 0.17, p = 0.000). Procedure time was reduced in Group K by 15.6%. Other aspects were the same in both groups. Conclusion: KCC prevented intraoperative bleeding just as FCC did. But it decreased device replacement and saved time and only a low risk was involved. This technique could ensure the conduct of a smooth and safe procedure during gastric ESD. UMIN000017229.