Scissor-type knife significantly improves self-completion rate of colorectal endoscopic submucosal dissection: Single-center prospective randomized trial

Objectives Colorectal endoscopic submucosal dissection (C-ESD) is recognized as a difficult procedure. Recently, scissors-type knives were launched to reduce the difficulty of C-ESD. The aim of this study was to evaluate the efficacy and safety of the combined use of a scissors-type knife and a needle-type knife with a water-jet function (WJ needle-knife) for C-ESD compared with using the WJ needle-knife alone. Methods This was a prospective randomized controlled trial in a referral center. Eighty-five patients, with superficial colorectal neoplasms, were enrolled and randomly assigned to undergo C-ESD using a WJ needle-knife alone (Flush group) or a scissors-type knife supported WJ needle-knife (SB Jr group). The procedures were conducted by two supervised trainees. Primary endpoint was self-completion rate by the trainees. Results Self-completion rate was 66.7% in the SB Jr group, which was significantly higher than that in the Flush group (39%, P = 0.01). Even after exclusion of four patients in the SB Jr group in whom C-ESD was completed using the WJ needle-knife alone, the self-completion rate was significantly higher (62.8% vs. 39%; P = 0.03). The median procedure time among the self-completion cases did not differ significantly between the two groups (58.5 vs. 50.5 min; P = 0.14). No severe adverse events were observed in either group. Conclusions In this single center phase II trial, scissors-type knife significantly improved trainees’ self-completion rate for C-ESD, with no increase in procedure time or adverse events. A multicenter trial would be warranted to confirm the validity of the present study. This article is protected by copyright. All rights reserved.