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

Endoscopic submucosal dissection(ESD)is a globally accepted minimally invasive therapy for early-stage gastrointestinal tract tumors.Although numerous electrosurgical knives have been developed for ESD,technical difficulties and high complication rates(bleeding and perforation)have limited their use worldwide.The grasping-type scissors forceps[clutch cutter(CC)]is the first forceps-type resection device developed with reference to hemostatic forceps.The aim was to allow easy and safe ESD throughout the gastro-intestinal tract,as a biopsy technique,using one device.The CC can grasp the target tissue accurately and pull it away from the underlying muscle layer prior to energizing the tissue,for safe and effective incision and hemostasis during ESD.Reported clinical studies showed that ESD using the CC(ESD-CC)is a safe(perforation rate:0%-3.6%;delayed bleeding rate:0%-4.2%),technically efficient(en-bloc resection rate:88.9%-100%),and single-device method for dissecting early-stage gastrointestinal tract tumors.The ESD-CC technique is simple and easy to learn because it can be completed simply by repeating the grasp,pull,and coagulate and/or incise actions using an electrosurgical current.The reported self-completion rate by nonexperts was significantly better with the CC than with conventional knives(61.7%vs 24.5%,respectively;P<0.001).Furthermore,the CC is used for other endoscopic therapies,such as endoscopic polypectomy for large pedunculated polyps,endoscopic myotomy for Zenker’s diverticulum,endoscopic treatment of buried bumper syndrome,and endoscopic necrosectomy for wall-off pancreatic necrosis.The initial reports using CC for these therapies have shown favorable results.In this review,we describe the structural features of the CC,how to use the instrument,efficacies of ESD-CC,and other unique endoscopic therapies using the CC.

Endoscopic submucosal dissection of gastric adenomas using the clutch cutter

To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) using the clutch cutter (CC) (ESD-CC) for gastric adenoma (GA). METHODSFrom June 2007 to August 2015, 122 consecutive patients with histological diagnoses of GA from specimens resected by ESD-CC were enrolled in this prospective study. The CC was used for all ESD steps (marking, mucosal incision, submucosal dissection, and hemostatic treatment), and its therapeutic efficacy and safety were assessed. RESULTSBoth the en-bloc resection rate and the R0 resection rate were 100% (122/122). The mean surgical time was 77.4 min, but the time varied significantly according to tumor size and location. No patients suffered perforation. Post-ESD-CC bleeding occurred in six cases (4.9%) that were successfully resolved by endoscopic hemostatic treatment. CONCLUSIONESD-CC is a technically efficient, safe, and easy method for resecting GA.

Vinyl bag cover method to avoid droplet-containing aerosol escape from endoscopic forceps channel caps during COVID-19 pandemic(with Video 1 and Video 2)

Endoscopists are at high risk of allowing transmission of coronavirus disease 2019(COVID-19)during gastrointestinal endoscopy(GIE)procedures under pandemic conditions.The main avenues of droplet-containing aerosol generated during GIE are the mouth,anus,and endoscopic forceps channel.Although the usefulness of personal protective equipment for preventing COVID-19 dissemination has been well reported,measures to address infected aerosol escaping during endoscopic forceps use have been neglected.Pathogen-contaminated aerosol from the endoscopic forceps channel,leading into the gastrointestinal lumen,has been confirmed and is a highly problematic source of infection.We developed a technique that entails covering the forceps entry/exit hole with a vinyl bag,thereby preventing contamination of the endoscopy room by the infected aerosol that escapes from this hole.The technique can be used in daily clinical endoscopic practice.Furthermore,this shielding technique is useful for all patients who undergo GIE,regardless of the purpose of the procedure such as for making a diagnosis,administering therapy,or in an urgent situation.In this letter,we introduce our novel,easily performed,inexpensive method of infection prevention by disallowing infected aerosol to escape from a COVID-19-infected patient into the air during a procedure that requires the use of endoscopic forceps.