Endoscopic submucosal dissection (ESD) is a method of resecting gastrointestinal lesions that allows for curative en bloc resection of large, flat lesions. However, ESD is technically challenging and difficult to learn. The risk of perforation remains a significant barrier to its widespread usage. Unlike conventional ESD knives, the Clutch Cutter knife allows for tissue grasping prior to electrosurgical incision, helping improve cut precision. We aimed to determine whether use of the Clutch Cutter improved safety among novice performers of ESD. We prospectively studied gastroenterology trainees and staff without experience in ESD. Participants performed ESD on an ex-vivo porcine stomach model. We compared the differences in ESD performance using the Clutch Cutter and a conventional knife (Hook knife). Participants were provided a brief theoretical introduction to ESD. A short hands-on session to practice using the knives in the animal model followed. Participants then performed circumferential incision and submucosal dissection of two, 2 cm (diameter) marked and submucosally lifted lesions. One excision was performed with the Clutch Cutter and the other with the conventional knife. Participants were individually randomized to use a certain knife first. We recorded adverse events (including full-thickness perforation, target sign, and unintentional incision), procedure time, and successful en bloc resection for each dissection. Continuous variables were compared using paired t-test; categorical variables were compared using Chi-squared analysis. P-values <0.05 were considered statistically significant. Seven endoscopists (5 trainees and 2 staff) participated in this study. Prior endoscopic experience ranged from 430-5000 (median 726) endoscopies, but all participants were novice to performing ESD. Compared to the conventional knife, use of the Clutch Cutter was associated with a significantly lower rate of perforation or target sign (14.3% vs. 71.4%, P=0.031), and unintentional incision (0% vs. 85.7%, P=0.001) (Table 1). All perforations and target signs in both groups were incurred during submucosal dissection. When compared to the conventional knife, use of the Clutch Cutter was associated with a trend towards longer time to completion of circumferential incision (median 18 min vs. 8 min, P=0.112), but shorter time to completion of submucosal dissection (median 3 min vs. 15 min, P=0.094). The total procedure time was not significantly different between use of the Clutch Cutter and conventional knife (median 23 min vs. 20 min, P=0.738). Among novices performing ESD on an animal model, use of the Clutch Cutter knife was associated with a significantly lower rate of adverse events without prolonging procedure time. Based on limited data, the Clutch Cutter appears to improve ESD safety, at least among learners.Tabled 1Outcomes of endoscopic submucosal dissection using the Clutch Cutter and a conventional knife.Clutch Cutter (n=7)Conventional knife (n=7)P-valueAdverse eventsPerforation14.3% (1/7)28.6% (2/7)0.094Target sign14.3% (1/7)57.1% (4/7)0.031Perforation or target sign14.3% (1/7)71.4% (5/7)0.031Unintentional incision0% (0/7)85.7% (6/7)0.001Median no. unintentional incision per resection02 (IQR 1-3)0.036Time to initial incision (sec)150 (IQR 36, 220)22 (IQR 15, 65)0.071Circumferential incision time (min)18 (IQR 11, 20)8 (IQR 2, 9)0.112Submucosal dissection time (min)3 (IQR 2, 14)15 (IQR 7, 18)0.094Total procedure time (min)23 (IQR 17, 38)20 (IQR 14, 24)0.738En bloc resection100% (7/7)71.4% (5/7)0.127IQR, interquartile range Open table in a new tab