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CC BY 4.0 · Endosc Int Open
DOI: 10.1055/a-2733-0944
Original article

The safety and efficiency of scissor-type knives in colorectal Endoscopic submucosal dissection: An International multicenter observational study

Authors

  • Kuilang Liu

    1   Beijing Shijitan Hospital Capital Medical University, Beijing, China (Ringgold ID: RIN117968)
    2   Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, Japan (Ringgold ID: RIN26455)

  • Jing Wu 

    3   Gastroenterology, Beijing Shijitan Hospital Capital Medical University, Beijing, China (Ringgold ID: RIN117968)
    4   Gastroenterology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China (Ringgold ID: RIN26455)

  • Yuzuru Tamaru

    5   Department of Gastroenterology, Kure Medical Center and Chugoku Cancer Center, Kure, Japan (Ringgold ID: RIN37086)

  • Yadan Wang

    3   Gastroenterology, Beijing Shijitan Hospital Capital Medical University, Beijing, China (Ringgold ID: RIN117968)

  • Hui Su

    6   Gastroenterology Department, Beijing Shijitan Hospital Capital Medical University, Beijing, China (Ringgold ID: RIN117968)

  • Chunmei Guo

    3   Gastroenterology, Beijing Shijitan Hospital Capital Medical University, Beijing, China (Ringgold ID: RIN117968)

  • Canghai Wang

    7   Gastroenterolgy, Beijing Shijitan Hospital Capital Medical University, Beijing, China (Ringgold ID: RIN117968)

  • Hong Liu

    3   Gastroenterology, Beijing Shijitan Hospital Capital Medical University, Beijing, China (Ringgold ID: RIN117968)

  • Makoto Kobayashi

    8   Department of Gastroenterology, Yokkaichi Municipal Hospital, Yokkaichi, Japan (Ringgold ID: RIN37036)

  • Kiyoaki Honma

    9   Nihonkai General Hospital, Sakata, Japan (Ringgold ID: RIN157373)

  • Takuya Yamada

    10   Department of Gastroenterology, Osaka Rosai Hospital, Sakai, Japan (Ringgold ID: RIN13824)

  • Levchenko Evgeniy

    11   Endoscopy Department, City Hospital No. 2, St. Petersburg, Russia, St. Petersburg, Russia, Russian Federation

  • Noor Mohammed

    12   Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN4472)

  • Sergio Cadoni

    13   Digestive Endoscopy Unit, CTO Hosptital, Iglesias, Italy

  • Adolfo Parra-Blanco 

    14   NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust, nottingham, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN9820)

  • Antipova Mariya

    15   Saint Petersburg State Budgetary Institution of Healthcare, City Mariinskaya Hospital, Saint Petersburg, Russian Federation

  • Sauid Ishaq 

    16   Aston University, Aston University, Birmingham, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN1722)
    17   Health and science, Dudley Group of Hospitals NHS Trust, Dudley, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN7714)

  • Toshio Kuwai 

    18   Gastrointestinal Endoscopy and Medicine, Hiroshima University Hospital, Hiroshima, Japan (Ringgold ID: RIN68272)

Clinical Trial:

Registration number (trial ID): UMIN000031511, Trial registry: UMIN Japan (http://www.umin.ac.jp/english/), Type of Study: Prospective Multi-Center Study


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Background and Aims: Scissor-type knives have shown safety and efficacy in endoscopic submucosal dissection (ESD) procedures, particularly in studies from Japan. However, the safety and efficacy of these devices in international settings, particularly outside Japan is not well established. Methods: This is prospective, multicenter, observational study conducted across nine international centers, encompassing a total of 461 lesions from 460 patients. In subgroup analysis, 162 lesions came from four institutions in Japan (Japanese institutions group, JAG) and 299 lesions from five institutions outside Japan ( non-Japanese institutions group, NJAG).After 1:1 propensity score matching resulted in 120 matched pairs of lesions， key outcomes were compared between groups. Results: The overall perforation rate during ESD procedures was 0.87%. Intraoperative perforations were observed more frequently in NJAG than JAG (3 vs 1 event, 1.9% vs. 0.33%, respectively), although not statistically significant (p = 0.127). The overall incidence of delayed bleeding was also 0.87%, with no delayed bleeding reported in NJAG. Post propensity matching analysis revealed a significantly slower median resection speed in NJAG compared to JAG(9.12 0.86–56.57 vs 26.21 1.95–93.54 mm²/min, p < 0.001). Both histological complete resection and curative resection rates were significantly lower in NJAG than in JAG with rates of 88.3% vs 98.3% for histological complete resection and 83.3% vs 95% for curative resection (both p < 0.01). Conclusions: The use of scissor-type knives in colorectal ESD outside Japan demonstrated a favorable safety profile. However, certain performance outcomes, such as resection speed and resection success rates, were inferior to Japanese institutions.



Publication History

Received: 09 December 2024

Accepted after revision: 24 October 2025

Accepted Manuscript online:
27 October 2025

© . The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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Bibliographical Record
Kuilang Liu, Jing Wu, Yuzuru Tamaru, Yadan Wang, Hui Su, Chunmei Guo, Canghai Wang, Hong Liu, Makoto Kobayashi, Kiyoaki Honma, Takuya Yamada, Levchenko Evgeniy, Noor Mohammed, Sergio Cadoni, Adolfo Parra-Blanco, Antipova Mariya, Sauid Ishaq, Toshio Kuwai. The safety and efficiency of scissor-type knives in colorectal Endoscopic submucosal dissection: An International multicenter observational study. Endosc Int Open ; 0: a27330944.
DOI: 10.1055/a-2733-0944