Scissor-Type Knife Improves Trainee's Self-Completion of Endoscopic Submucosal Dissection for Early Gastric Cancer

This retrospective study aimed to verify the efficacy of endoscopic submucosal dissection (ESD) using a scissor-type knife for early gastric cancer (EGC).

The patients who underwent ESD for EGC between April 2014 and March 2022 were enrolled. The primary endpoint of this study was to assess the efficacy of a scissor-type knife by comparing the self-completion rate of trainees between gastric ESD performed using a scissor-type knife (ESD-SC) and nonscissor devices (ESD-NS).

Of the 903 lesions, 485 and 418 underwent ESD-SC and ESD-NS, respectively. The self-completion rate of trainees was significantly higher for ESD-SC than for ESD-NS (50.3 and 33.0%, respectively; p < 0.001). The procedure time was also significantly shorter for ESD-SC (50.0 vs. 66.5 min, respectively; p < 0.001). Intraoperative perforation rate was not significantly different (0.6% for ESD-SC and 1.4% for ESD-NS, respectively). In multivariate analyses, tumor located in the lower third of the stomach (odds ratio [OR] 1.93, 95% confidence interval [CI] 1.46-2.55, p < 0.001), tumor size ≤ 20 mm (OR 3.32, 95% CI 2.20-5.00, p < 0.001), and a scissor-type knife (OR 2.22, 95% CI 1.67-2.94, p < 0.001) were factors related to the self-completion rate of trainees for gastric ESD.

A scissor-type knife was associated with higher self-completion rates and shorter procedure times among trainees. Further prospective studies are needed to validate its clinical utility in ESD training.