title: Endoscopic submucosal dissection for rectal carcinoid tumour using the Clutch Cutter.
abstract: BACKGROUND
  To reduce the risk of complications related to endoscopic submucosal dissection (ESD) using knives, we developed the Clutch Cutter (CC), which can grasp and incise the target tissue similarly to biopsy techniques using an electrosurgical current. The aim of this study was to evaluate the efficacy and safety of ESD using the CC for removal of rectal carcinoid tumours.
  
  
  METHODS
  Between December 2009 and December 2011, we prospectively enrolled seven patients (seven lesions) on 7 different days. Patients were endoscopically diagnosed with rectal subepithelial lesions (upper rectum, n = 3; lower rectum, n = 4) within the level 3 layer and without lymph node involvement, with the diagnosis confirmed by preliminary endoscopy, endoscopic ultrasound and endoscopic biopsies. ESD using the CC was performed in all cases, and the therapeutic efficacy, safety and tumour recurrence were assessed.
  
  
  RESULTS
  All lesions were treated easily and safely, and there were no inadvertent incisions. En bloc resection was obtained in all cases, and histologic tumour-free lateral/basal margins were obtained in six of the seven patients. No delayed haemorrhage, perforation or tumour recurrence occurred.
  
  
  CONCLUSIONS
  ESD using the CC appears to be an easy, safe and technically efficient method for resecting rectal carcinoid tumour.
authors.affiliation: Department of Gastroenterology, Aso Iizuka Hospital, Iizuka, Japan.
authors.forename: Keishi
authors.initials: K
authors.lastname: Komori
authors.forename: Kazuya
authors.initials: K
authors.lastname: Akahoshi
authors.forename: Masaru
authors.initials: M
authors.lastname: Kubokawa
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Motomura
authors.forename: Masafumi
authors.initials: M
authors.lastname: Oya
authors.forename: Eikichi
authors.initials: E
authors.lastname: Ihara
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nakamura
mesh_terms: D000368:Aged; D001706:Biopsy; D002276:Carcinoid Tumor / Q000175:diagnosis / Q000601:surgery*; D020685:Colonoscopes; D003113:Colonoscopy / Q000295:instrumentation*; D004210:Dissection / Q000379:methods*; D019160:Endosonography; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D012007:Rectum / Q000000981:diagnostic imaging / Q000473:pathology; D013997:Time Factors; D016896:Treatment Outcome
keywords: Clutch Cutter; carcinoid tumour; endoscopic submucosal dissection; endoscopic surgery; subepithelial lesion