Advances in endoscopic therapy using grasping-type scissors forceps (with video)

Table 1 Power settings of endoscopic submucosal dissection using the clutch cutter for high frequency generator

Procedure	VIO 31		VIO 300D2
	Mode	Setting	Mode	Setting
Marking	FORCED COAG	Effect 7	FORCED COAG	30 W effect 3
Mucosal incision/Submucosal dissection	ENDO CUT I	Effect 2	ENDO CUT Q	Effect 2
		Duration 1		Duration 3
		Interval 3		Interval 1
Hemostatic treatment	SOFT COAG	Effect 6	SOFT COAG	100 W effect 5

¹VIO 3 (Erbe Elektromedizin, Tübingen, Germany).

²VIO 300D (Erbe Elektromedizin, Tübingen, Germany).

Table 2 Reported clinical outcomes of endoscopic submucosal dissection using the clutch cutter

Ref.	Organ	Numberof patients	Histology	Procedure time, min	En bloc (R0) resection rate %	Perforation rate % (n)	Delayed bleeding rate % (n)	Surgical1 intervention rate % (n)
Sawas et al[18], 2018	Esophagus	14	ADCA, DYS	ND	100 (41.6)	0 (0)	0 (0)	0 (0)
Esaki et al[19], 2020	Esophagus	36	SCC	56.4	88.9 (80.6)	0 (0)	0 (0)	0 (0)
Hanada et al[20], 2020	Esophagus	96	ADCA, DYS, SCC	78.3	94.3 (ND)	0 (0)	1.4 (2)	0 (0)
Akahoshi et al[6], 2015	Stomach	325	ADCA	97.2	99.7 (95.3)	0.3 (1)	3.4 (11)	0 (0)
Nagai et al[21], 2016	Stomach	56	ADCA, ADM	66	93 (ND)	3.6 (2)	3.6 (2)	0 (0)
Hayashi et al[22], 2018	Stomach	50	ADCA	49	100 (100)	0 (0)	2.3 (1)	0 (0)
Dohi et al[23], 2019	Stomach	61	ADCA	44	100 (93.4)	0 (0)	0 (0)	0 (0)
Dohi et al[24], 2020	Duodenum	47	ADCA, ADM	36	100 (97.9)	2.1 (1)	4.2 (2)	0 (0)
Akahoshi et al[8], 2019	Colorectum	437	ADCA, ADM	88.3	99.3 (87.0)	2.3 (10)	2.3 (10)	0 (0)
Yoshida et al[12], 2019	Colorectum	51	ND	56	98 (ND)	2.0 (ND)	0 (0)	ND

¹Surgical intervention owing to endoscopic submucosal dissection-related complications. ESD: Endoscopic submucosal dissection; SCC: Squamous cell carcinoma; ADCA: Adenocarcinoma; DYS: Dysplasia; ADM: Adenoma; ND: Not described.

Table 3 Reported comparison studies of the clinical outcomes of endoscopic submucosal dissection using the clutch cutter vs using conventional knives

Organ	Ref.		ESD using the clutch cutter	ESD using the conventional knives	P value
Esophagus	Esaki et al[19], 2020	Type of knife	-	IT-KN, DK, FK, SMK	-
		Number of patients1	36	36	-
		Median procedure time (min)	44	66.5	0.02
		En-bloc resection rate (%)	100	97.2	1
		R0 resection rate (%)	88.9	86.1	1
		Perforation rate (%)	0	5.6	0.20
		Delayed bleeding rate (%)	0	0	-
Stomach	Nagai et al[21], 2016	Type of knife	-	IT-2K	-
		Number of patients	56	61	-
		Median procedure time (min)	66	41	0.04
		En-bloc resection rate (%)	93	98	0.195
		R0 resection rate (%)	ND	ND	-
		Perforation rate (%)	3.6	1.6	-
		Delayed bleeding rate (%)	3.6	1.6	-
Stomach	Hayashi et al[22], 2018	Type of knife	-	IT-2K,SMK	-
		Number of patients1	44	44	-
		Median procedure time (min)	49	88.5	<0.001
		En-bloc resection rate (%)	100	100	-
		R0 resection rate (%)	100	100	-
		Perforation rate (%)	0	0	-
		Delayed bleeding rate (%)	2.3	6.8	0.620
Stomach	Dohi et al[23], 2019	Type of knife	-	IT-2K	-
		Number of patients1	61	61	-
		Median procedure time (min)	44	56	0.005
		En-bloc resection rate (%)	100	100	1
		R0 resection rate (%)	93.4	100	0.06
		Perforation rate (%)	0	4.9	0.12
		Delayed bleeding rate (%)	0	6.6	0.06
Duodenum	Dohi et al[24], 2020	Type of knife	-	FK	-
		Number of patients	47	37	-
		Median procedure time (min)	36	54	0.045
		En-bloc resection rate (%)	100	94.6	0.191
		R0 resection rate (%)	97.9	83.8	0.04
		Intra-ESD perforation rate (%)	0	4.9	0.014
		Delayed perforation rate (%)	2.1	8.1	0.316
		Delayed bleeding rate (%)	4.2	0	0.501

¹A Propensity Score-Matched Analysis. ESD: Endoscopic submucosal dissection; ITKN: IT-knife nano; DK: Dual knife; FK: Flush knife; SMK: Splash M-knife; IT-K2: Insulated-tip knife-2; ND: Not described.