Post written by Naohisa Yoshida, MD, PhD, from the Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan.

A lesion on the dental line area is challenging for ESD because it has lots of vessels, and the anal duct is narrow for approach. We described how to perform ESD for this kind of difficult lesion with a Clutch Cutter (FUJIFILM). This knife is a scissor-type shape and enables mucosal incision, submucosal dissection, and hemostasis. Colorectal ESD with a Clutch Cutter is promising for overcoming various difficult situations.

ESD is still difficult in the West. The Clutch Cutter enabled us to perform ESD on the lesion in the dentate line area, control perioperative hemorrhage, and prevent perforation. They imagine ESD is regularly performed by a needle-type knife and a blade-type knife. A scissor-type knife is less prevalent, but it is a useful option especially for non-expert endoscopists.

The Clutch Cutter is also useful for a lesion that has severe breathing movement in the proximal colon. Because tissue is caught with this knife and then cut or dissected electrosurgically. The outside of this knife is insulated. As such, there are no unintentional perforations, in contrast to other needle-type knives. Honestly, this knife seems slower than other needle-type knives. However, as a result, to control peri-operative hemorrhage and dissect tissue step by step with this knife makes ESD faster. One more tip for this knife is that an assistant has to train themselves to rotate this knife better before the procedure.

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