Prospective Comparison of Needle Knives With Scissor Knives for Colorectal Endoscopic Submucosal Dissection

This is a post-hoc propensity score-matched analysis of 2498 colorectal lesions removed with needle-type or scissor-type knives for endoscopic submucosal dissection (ESD) in 11 Japanese facilities over 5 years. Needle-type knives were used in the removal of 2067 lesions, and scissor-type knives were used in 431 lesions. 

Overall, 41% of the lesions were granular, 17.5% had submucosal cancer, and the mean tumor size was 30 mm. Before matching, the needle-type and scissor-type knife groups differed in multiple factors, including mean age, anticoagulant and antiplatelet use, lesion morphology, presence of severe submucosal fibrosis, cancer, histology, and lesion size. After propensity score matching, there were no differences in patient or lesion features in 407 included lesions removed with scissor-type knives and 814 lesions removed using needle-type knives in the matched propensity score analysis (1:2 matching ratio).

Resection speed was faster with needle-type knives (18.3 mm^2/minute) compared with the scissor-type (13.2 mm^2/minute; P<.0001), but en bloc resection rates (96.8% vs 98.3%, respectively) and R0 resection rates (95.1% and 95.6%) were not different. Procedure completion with a single knife was lower in the needle-type group than the scissor-type group (43.9% vs 98.5%; P<.0001).

The intraoperative perforation rates were 0.7% with scissor-type knives and 2.5% with needle-type knives (P=.04), and the delayed bleeding rate was also lower with the scissor-type (0.7% vs 2.5%; P=.04).