Post written by Toshio Kuwai, MD, PhD, from the Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan.

In this study, we primarily focused on the safety of colorectal endoscopic submucosal dissection (ESD) using a scissor-type knife in comparison to a needle-type knife. For more information, please visit our GIE author interview on YouTube.

Despite the considerable advantages of ESD, including the ability to control resection size and promote high curative resection and low local recurrence rates, the adoption of colorectal ESD is not widespread because of technical challenges. Needle-type knives are commonly used for colorectal ESD, and these conventional ESD knives have freehand tips and are used without fixing the target, creating a potential risk of perforation because of unexpected incision.

More recently, scissor-type knives, such as the SB Knife Jr (Sumitomo Bakelite Co, Tokyo, Japan), have become available in the United States, and we have reported their efficacy and safety. Colorectal ESD using a scissor-type knife employs a technique similar to that used during biopsy that does not require advanced skill and complex endoscopic manipulation.

The basic colorectal ESD procedure using a scissor-type knife comprises 3 steps: (1) grasping, (2) pulling, and (3) cutting. Therefore, it could be performed relatively safely and easily.

However, no evidence for the efficacy and safety of this procedure has been available because of the absence of studies comparing the same in different types of knives for colorectal ESD. Therefore, this study was conducted to address such paucity of information. We observed that intraoperative perforation and delayed bleeding rates in colorectal ESD were significantly lower when using a scissor-type knife than when using a needle-type knife.

Based on these data, we revealed that the scissor-type knife allows for safer colorectal ESD, suggesting its usefulness for not only trainees but also experts as a secondary device in difficult situations.

In contrast, we also revealed the disadvantage of scissor-type knives: slower resection speed than needle-type knives. To address this concern, new devices are being developed. For example, the SB Knife Jr (called SB Knife Jr 2) launched in 2019 is available, albeit only in Japan. This new knife is equipped with a rotation handle for 1-to-1 blade rotation that facilitates easy manipulation by an assistant.

In addition, new coating materials to prevent unnecessary diathermy burn and a new blade design with a protrusion might contribute to a speedier resection.

Although the effectiveness of these countermeasures should be subsequently evaluated, we believe that the scissor-type knife will contribute to the global utilization of colorectal ESD, considering its safety and ease of use.

Graphical Abstract

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