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)

Background and Aims: Many knives have been developed to improve the efficacy and safety of endoscopic submucosal dissection (ESD). We aimed to evaluate the efficacy and safety of scissor-type knives for colorectal ESD compared with needle-type knives. Methods: We performed a post-hoc propensity score-matched analysis in an 11-facility study between August 2013 and December 2018. A total of 2330 patients (2498 lesions) who underwent colorectal ESD were divided into needle-type (1923 patients, 2067 lesions) and scissor-type (407 patients, 431 lesions) knife groups. Short-term outcomes were compared between the 2 groups. Results: Two-to-one propensity score-matched analysis identified 814 (709 patients) and 407 (386 patients) lesions in the needle- and scissor-type knife groups, respectively. The median resection speed was significantly faster in the needle-type group (18.3mm(2)/min) than in the scissor-type group (13.2mm(2)/min, P < .0001), whereas en-bloc and histologic complete resection rates were not significantly different between the needle- and scissor-type groups (96.8%[788/814] vs 98.3%[400/407], P = .1888 and 95.1%[774/814] vs 95.6%[389/407], P = .7763, respectively). The rate of lesions resected using a single knife was significantly higher in the scissor-type group (98.5% [401/407]) than in the needle-type group (43.9%[357/814], P < .0001). Rates of intraoperative perforation and delayed bleeding were significantly lower in the scissor-type group than in the needle-type group (.7% [3/407] vs 2.5% [20/814], P = .0431 for each). Conclusions: Scissor-type knives are safer for colorectal ESD. However, they are associated with slower resection speeds compared with needle-type knives.