Endoscopic submucosal dissection of early duodenal tumor using the Clutch Cutter: a preliminary clinical study.

Endoscopic submucosal dissection (ESD) is a minimally invasive method of treating early-stage tumors of the digestive tract. However, duodenal ESD is technically difficult, with high complication rates resulting from poor control of the endoscope, the thin duodenal wall, and the potential for exposure to pancreatic juices [1–2]. This study evaluated the safety of ESD using the short-type Clutch Cutter for the removal of early duodenal tumors. The short-type Clutch Cutter (DP2618DT; Fujifilm Corporation, Tokyo, Japan) (●" Fig.1) has previously been described in detail [3]. When the Clutch Cutter is being used for ESD of duodenal tumors, electrical damage to the thin muscle layer can be prevented by grasping the tissue and lifting it from the underlying proper muscle layer, before cutting or coagulating it. The steps of the ESD technique using the Clutch Cutter are illustrated in ●" Fig.2. Between September 2009 and December 2014, seven patients endoscopically diagnosed with early duodenal tumors underwent ESD using the Clutch Cutter (●" Table 1;●" Fig.3). Preliminary esophagogastroduodenoscopy (EGD), endoscopic ultrasound (EUS), and endoscopic biopsy showed no evidence of lymph node metastasis in any of the patients. Almost all post-ESD ulcers were closed with clips to prevent delayed perforation. After ESD, all patients were treated with intravenous fluids and antibiotics for at least 2 days, andwith an acid-suppression agent (rabeprazole 10mg/day) for a minimum of 6 weeks. Clinical outcomes are summarized in ●" Table 1. All lesions were resected easily and safely in one piece. There were no complications. Follow-up EGD at a mean of 8.7 months showed no incidence of tumor recurrence. Although endoscopically normal tissue had been excised in all patients, the margins could not be assessed pathologically in some of the patients, most likely as a result of heat denaturation. Although we assessed only a few patients, this study showed that ESD using the Clutch Cutter was safe for duodenal tumors.