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

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

[METHODS] 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).

[RESULTS] 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.

[CONCLUSIONS] 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.