Comparative effectiveness of the Clutch Cutter versus Dual knife for esophageal endoscopic submucosal dissection by non-expert endoscopists: a single-center retrospective cohort study

BACKGROUND: A Clutch Cutter is a grasping scissor forceps device used for endoscopic submucosal dissection (ESD). This device can grasp and incise the target tissue similar to the action of a biopsy forceps. Therefore, ESD with a Clutch Cutter may be easier and safer than that performed with non-scissor-type knives. This study verified the usefulness of the Clutch Cutter by nonexpert endoscopists during ESD for superficial esophageal cancer. METHODS: This single-center retrospective cohort study enrolled 125 patients who underwent ESD as a first-line therapy for superficial esophageal cancer between January 2016 and June 2023 at Saiseikai Suita Hospital. The patients were divided into groups based on the ESD device: a Clutch Cutter or a non-scissor-type device (dual knife). The clinical characteristics and technical outcomes were compared between the two groups. RESULTS: Among one hundred twenty-five patients, seventy-nine patients underwent nonexpert endoscopic treatment, of which twenty-one patients underwent ESD with a Clutch Cutter and fifty-eight patients with a dual knife. There is a significant difference in sex distribution between the two groups, with a higher percentage of males in the dual knife group (94.8%) compared to the Clutch Cutter group (71.4%) (p = 0.01). Patients in the Clutch Cutter group had shorter procedure times (60 min) than those in the dual knife group (93 min) (p = 0.002). However, en bloc and R0 resection rates were not significantly different between the groups. In the multivariate analysis, procedure time (min) was significantly correlated with device type (coefficient 58.86, 95% confidence interval: 26.99-90.72) and tumor size (coefficient 4.9, 95% confidence interval: 3.58-6.21). CONCLUSION: ESD for superficial esophageal cancer with the Clutch Cutter significantly shortened procedure time compared to that with the dual knife for nonexpert endoscopists. Therefore, the Clutch Cutter may be a preferred-device for nonexpert endoscopists.