Download PDF
Open Access
CC BY 4.0 · Endosc Int Open 2025; 13: a27330944
DOI: 10.1055/a-2733-0944
Original article

Safety and efficacy of scissor-type knives in colorectal endoscopic submucosal dissection: International multicenter observational study

Authors

  • Kuilang Liu‡

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

  • Jing Wu  ‡

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

  • Yuzuru Tamaru

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

  • Yadan Wang

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

  • Hui Su

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

  • Chunmei Guo

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

  • Canghai Wang

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

  • Hong Liu

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

  • Makoto Kobayashi

    4   Gastroenterology, Yokkaichi Municipal Hospital, Yokkaichi, Japan (Ringgold ID: RIN37036)

  • Kiyoaki Honma

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

  • Takuya Yamada

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

  • Levchenko Evgeniy

    7   Endoscopy Department, City Hospital No. 2, St. Petersburg, Russia

  • Noor Mohammed

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

  • Sergio Cadoni

    9   Digestive Endoscopy Unit, CTO Hosptital, Iglesias, Italy

  • Adolfo Parra-Blanco 

    10   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

    11   Saint Petersburg State Budgetary Institution of Healthcare, City Mariinskaya Hospital, St. Petersburg, Russia

  • Sauid Ishaq 

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

  • Toshio Kuwai 

    14   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


Further Information
Also available at
  Permissions and Reprints

Abstract

Background and study 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.

Patients and methods

This was a 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). 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 with 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

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.

Keywords

Endoscopy Lower GI Tract - Colorectal cancer - Polyps / adenomas / ... - Endoscopic resection (polypectomy, ESD, EMRc, ...)


Publication History

Received: 09 December 2024

Accepted after revision: 24 October 2025

Accepted Manuscript online:
27 October 2025

Article published online:
11 November 2025

© 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/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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. Safety and efficacy of scissor-type knives in colorectal endoscopic submucosal dissection: International multicenter observational study. Endosc Int Open 2025; 13: a27330944.
DOI: 10.1055/a-2733-0944
 

  • References

  • 1 Pimentel-Nunes P, Libânio D, Bastiaansen BAJ. et al. Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2022. Endoscopy 2022; 54: 591-622
    Search in Google Scholar
  • 2 Fuccio L, Hassan C, Ponchon T. et al. Clinical outcomes after endoscopic submucosal dissection for colorectal neoplasia: a systematic review and meta-analysis. Gastrointest Endosc 2017; 86: 74-86
    Search in Google Scholar
  • 3 Saito Y, Yamada M, So E. et al. Colorectal endoscopic submucosal dissection: Technical advantages compared to endoscopic mucosal resection and minimally invasive surgery. Dig Endosc 2014; 26: 52-61
    Search in Google Scholar
  • 4 Singh RR, Nanavati J, Gopakumar H. et al. Colorectal endoscopic submucosal dissection in the West: A systematic review and meta-analysis. Endosc Int Open 2023; 11: E1082-E1091
    Search in Google Scholar
  • 5 Draganov PV, Wang AY, Othman MO. et al. AGA Institute Clinical Practice Update: Endoscopic Submucosal Dissection in the United States. Clin Gastroenterol Hepatol 2019; 17: 16-25 e1
    Search in Google Scholar
  • 6 Hayashi N, Tanaka S, Nishiyama S. et al. Predictors of incomplete resection and perforation associated with endoscopic submucosal dissection for colorectal tumors. Gastrointest Endosc 2014; 79: 427-435
    Search in Google Scholar
  • 7 Yahagi N, Uraoka T, Ida Y. et al. Endoscopic submucosal dissection using the Flex and the Dual knives. Tech Gastrointest Endosc 2011; 13: 74-78
    Search in Google Scholar
  • 8 Toyonaga T, Man- I, Fujita T. et al. The performance of a novel ball tipped Flush knife for endoscopic submucosal dissection: a case control study. Aliment Pharmacol Ther 2010; 32: 908-915
    Search in Google Scholar
  • 9 Homma K, Otaki Y, Sugawara M. et al. Efficacy of novel SB knife Jr examined in a multicenter study on colorectal endoscopic submucosal dissection. Dig Endosc 2012; 24: 117-120
    Search in Google Scholar
  • 10 Akahoshi K, Akahane H, Motomura Y. et al. A new approach: endoscopic submucosal dissection using the Clutch Cutter for early stage digestive tract tumors. Digestion 2012; 85: 80-84
    Search in Google Scholar
  • 11 Kuwai T, Yamaguchi T, Imagawa H. et al. Endoscopic submucosal dissection of early colorectal neoplasms with a monopolar scissor type knife: short- to long-term outcomes. Endoscopy 2017; 49: 913-918
    Search in Google Scholar
  • 12 Yoshida N, Dohi O, Inoue K. et al. Efficacy of scissor-type knives for endoscopic mucosal dissection of superficial gastrointestinal neoplasms. Dig Endosc 2020; 32: 4-15
    Search in Google Scholar
  • 13 Kuwai T, Tamaru Y, Kusunoki R. et al. SB Knife Jr: characteristics and tips on how to use. Mini-invasive Surg 2022; 6: 16
    Search in Google Scholar
  • 14 Kuwai T, Oka S, Kamigaichi Y. et al. Efficacy and safety comparison of scissor-type knives with needle-type knives for colorectal endoscopic submucosal dissection: a post-hoc propensity score-matched analysis (with videos). Gastrointest Endosc 2022; 96: 108-117
    Search in Google Scholar
  • 15 Gopakumar H, Vohra I, Reddy Puli S. et al. Comparison of scissor-type knife to non-scissor-type knife for endoscopic submucosal dissection: a systematic review and meta-analysis. Clin Endosc 2024; 57: 36-47
    Search in Google Scholar
  • 16 Tanaka S, Kashida H, Saito Y. et al. Japan Gastroenterological Endoscopy Society guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc 2020; 32: 219-239
    Search in Google Scholar
  • 17 Hashiguchi Y, Muro K, Saito Y. et al. Japanese Society for Cancer of the Colon and Rectum. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol 2020; 25: 1-42
    Search in Google Scholar
  • 18 Gopakumar H, Vohra I, Sharma NR. et al. Efficacy of scissor-type knife for endoscopic submucosal dissection: a systematic review and meta-analysis. Ann Gastroenterol 2023; 36: 615-623
    Search in Google Scholar
  • 19 Iwatsubo T, Takeuchi Y, Yamasaki Y. et al. Differences in clinical course of intraprocedural and delayed perforation caused by endoscopic submucosal dissection for colorectal neoplasms: A retrospective study. Dig Dis 2019; 37: 53-62
    Search in Google Scholar
  • 20 Yamashina T, Takeuchi Y, Nagai K. et al. Scissor-type knife significantly improves self-completion rate of colorectal endoscopic submucosal dissection: Single-center prospective randomized trial. Dig Endosc 2017; 29: 322-329
    Search in Google Scholar
  • 21 Yachida T, Kobara H, Kozuka K. et al. Comparison of needle knife versus scissors forceps for colorectal endoscopic submucosal dissection: A prospective randomized study. J Clin Med 2023; 12: 2329
    Search in Google Scholar
  • 22 Miyakawa A, Kuwai T, Sakuma Y. et al. Learning curve for endoscopic submucosal dissection of early colorectal neoplasms with a monopolar scissor-type knife: use of the cumulative sum method. Scand J Gastroenterol 2020; 55: 1234-1242
    Search in Google Scholar
  • 23 Jiang W, Cen L, Dong C. et al. Prophylactic clipping to prevent delayed bleeding and perforation after endoscopic submucosal dissection and endoscopic mucosal resection: A systematic review and meta-analysis. J Clin Gastroenterol 2022; 56: 643-653
    Search in Google Scholar
  • 24 Miyakawa A, Kuwai T, Sakuma Y. et al. The efficacy of prophylactic clip closure of mucosal defects after colorectal endoscopic submucosal dissection on delayed bleeding. Scand J Gastroenterol 2021; 56: 1236-1242
    Search in Google Scholar
  • 25 Chiba H, Ohata K, Ashikari K. et al. Effectiveness of strategy-focused training in colorectal endoscopic submucosal dissection: A retrospective observational study. Dig Dis Sci 2024; 69: 2370-2380
    Search in Google Scholar
  • 26 Chang MC, Chen WC, Yu HC. et al. Diving, lifting, and horizontal dissection followed by loop-clip traction (DLH+T) can facilitate mucosal flap creation during colorectal ESD. Surg Endosc 2022; 36: 7811-7817
    Search in Google Scholar
  • 27 Yang B, Yan P, Li X. et al. Effects of traction methods in inexperienced endoscopists during colorectal endoscopic submucosal dissection. Scand J Gastroenterol 2023; 58: 1056-1063
    Search in Google Scholar
  • 28 Tamaru Y, Kuwai T, Miyakawa A. et al. Efficacy of a traction device for endoscopic submucosal dissection using a scissor-type knife: A randomized controlled trial. Am J Gastroenterol 2022; 117: 1797-1804
    Search in Google Scholar
  • 29 Inoue K, Yoshida N, Dohi O. et al. Effects of the combined use of a scissor-type knife and traction clip on endoscopic submucosal dissection of colorectal tumors: a propensity score-matched analysis. Endosc Int Open 2021; 9: E1617-E1626
    Search in Google Scholar
  • 30 Gu F, Jiang W, Zhu J. et al. Risk factors for unsuccessful colorectal endoscopic submucosal dissection: A systematic review and meta-analysis. Dig Liver Dis 2024; 56: 1288-1297
    Search in Google Scholar