Clin Endosc.  2024 Jan;57(1):36-47. 10.5946/ce.2023.122.

Comparison of scissor-type knife to non-scissor-type knife for endoscopic submucosal dissection: a systematic review and meta-analysis

• Gopakumar H
• Vohra I
• Reddy Puli S
• R Sharma N

• KMID: 2551188
• DOI: http://doi.org/10.5946/ce.2023.122

Abstract

Background/Aims
Scissor-type endoscopic submucosal dissection (ST-ESD) knives can reduce the adverse events associated with ESDs. This study aimed to compare ST-ESD and non-scissor-type (NST)-ESD knives.
Methods
We identified ten studies that compared the performance characteristics and safety profiles of ST-ESD and NST-ESD knives. Fixed- and random-effects models were used to calculate the pooled proportions. Heterogeneity was assessed using the I2 test.
Results
On comparing ST-ESD knives to NST-ESD knives, the weighted odds of en bloc resection was 1.61 (95% confidence interval [CI], 0.90–2.90; p=0.14), R0 resection was 1.10 (95% CI, 0.71–1.71; p=0.73), delayed bleeding was 0.40 (95% CI, 0.17–0.90; p=0.03), perforation was 0.35 (95% CI, 0.18–0.70; p<0.01) and ESD self-completion by non-experts was 1.89 (95% CI, 1.20–2.95; p<0.01). There was no heterogeneity, with an I2 score of 0% (95% CI, 0%–54.40%).
Conclusions
The findings of reduced odds of perforation, a trend toward reduced delayed bleeding, and an improvement in the rates of en bloc and R0 resection with ST-ESD knives compared to NST-ESD knives support the use of ST-ESD knives when non-experts perform ESDs or as an adjunct tool for challenging ESD procedures.

Keyword

Clutch cutter; Endoscopic submucosal dissection; Endoscopic submucosal dissection knife; Grasping-type endoscopic submucosal dissection knife; Insulated tip knife; Scissor-type endoscopic submucosal dissection knife; Stag beetle knife

Figure

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  Fig. 1. The Stag-beetle knife (Sumitomo Bakelite).

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  Fig. 2. ClutchCutter knife (Fujifilm Medical).

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  Fig. 3. Study flow diagram according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. ST-ESD, scissor-type endoscopic submucosal dissection; NST-ESD, non-scissor-type endoscopic submucosal dissection.

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  Fig. 4. Forest plot comparing the odds of en bloc resection between the ST-ESD and NST-ESD knives. ST-ESD, scissor-type endoscopic submucosal dissection; NST-ESD, non-scissor-type endoscopic submucosal dissection.

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  Fig. 5. Forest plot comparing the odds of R0 resection between the ST-ESD and NST-ESD knives. ST-ESD, scissor-type endoscopic submucosal dissection; NST-ESD, non-scissor-type endoscopic submucosal dissection.

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  Fig. 6. Forest plot comparing the odds of delayed perforation between the ST-ESD and NST-ESD knives. ST-ESD, scissor-type endoscopic submucosal dissection; NST-ESD, non-scissor-type endoscopic submucosal dissection.

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  Fig. 7. Funnel plot showing no publication bias.

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  Fig. 8. Forest plot comparing the odds of self-completion of ESD when performed by non-experts using ST-ESD vs. NST-ESD knives. ST-ESD, scissor-type endoscopic submucosal dissection; NST-ESD, non-scissor-type endoscopic submucosal dissection.

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