title: Endoscopic Submucosal Dissection for Early Gastric Cancer using the Clutch Cutter: a large single-center experience.
abstract: OBJECTIVE
  The Clutch Cutter (CC) was developed to reduce the risk of complications related to endoscopic submucosal dissection (ESD) using knives. The CC is able to grasp and coagulate and/or incise the targeted tissue using electrosurgical current, like a biopsy technique. The aim of this study was to evaluate the efficacy and safety of ESD using the CC (ESD-CC) for early gastric cancer (EGC).
  
  
  METHODS
  From June 2007 to March 2014, 325 consecutive patients with a diagnosis of EGC were enrolled in this prospective study. They had all satisfied the Japanese gastric cancer treatment guidelines for ESD indication, namely confirmation by preliminary endoscopy, endoscopic ultrasound, and endoscopic biopsies. The CC was used for all steps of ESD (marking, circumferential marginal incision, submucosal dissection, and hemostatic treatment). The therapeutic efficacy and safety were assessed.
  
  
  RESULTS
  The en-bloc resection rate was 99.7 % (324/325) and the R0 resection rate was 95.3 % (310/325). The mean operating time was 97.2 minutes. Perforation during ESD-CC occurred in one case (0.3 %), which was managed with conservative medical treatment after endoscopic closure of the perforation. Post-ESD-CC bleeding occurred in 11 cases (3.4 %), which were successfully treated by endoscopic hemostatic treatment. The R0 resection rate was significantly low in tumors > 20 mm (88.9 %), and in the exclusion indication group (73.7 %). Significant differences were seen in the mean operating time, depending upon tumor size, histologic type, location, and indication criteria.
  
  
  CONCLUSIONS
  ESD-CC is a technically efficient, safe, and easy method for resecting EGC.
authors.affiliation: Department of Gastroenterology, Aso Iizuka Hospital, Iizuka, 820-8505 Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Akahoshi
authors.affiliation: Department of Gastroenterology, Aso Iizuka Hospital, Iizuka, 820-8505 Japan.
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Motomura
authors.affiliation: Department of Gastroenterology, Aso Iizuka Hospital, Iizuka, 820-8505 Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Kubokawa
authors.affiliation: Department of Gastroenterology, Aso Iizuka Hospital, Iizuka, 820-8505 Japan.
authors.forename: Junya
authors.initials: J
authors.lastname: Gibo
authors.affiliation: Department of Gastroenterology, Aso Iizuka Hospital, Iizuka, 820-8505 Japan.
authors.forename: Nobukatsu
authors.initials: N
authors.lastname: Kinoshita
authors.affiliation: Department of Gastroenterology, Aso Iizuka Hospital, Iizuka, 820-8505 Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Osada
authors.affiliation: Department of Gastroenterology, Aso Iizuka Hospital, Iizuka, 820-8505 Japan.
authors.forename: Kayo
authors.initials: K
authors.lastname: Tokumaru
authors.affiliation: Department of Gastroenterology, Aso Iizuka Hospital, Iizuka, 820-8505 Japan.
authors.forename: Taizou
authors.initials: T
authors.lastname: Hosokawa
authors.affiliation: Department of Gastroenterology, Aso Iizuka Hospital, Iizuka, 820-8505 Japan.
authors.forename: Naru
authors.initials: N
authors.lastname: Tomoeda
authors.affiliation: Department of Gastroenterology, Aso Iizuka Hospital, Iizuka, 820-8505 Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Otsuka
authors.affiliation: Department of Gastroenterology, Aso Iizuka Hospital, Iizuka, 820-8505 Japan.
authors.forename: Mie
authors.initials: M
authors.lastname: Matsuo
authors.affiliation: Department of Pathology, Aso Iizuka Hospital, Iizuka, 820-8505 Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Oya
authors.affiliation: Clinical Research Support Office, Aso Iizuka Hospital, Iizuka, 820-8505 Japan.
authors.forename: Hidenobu
authors.initials: H
authors.lastname: Koga
authors.affiliation: Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nakamura