Advances in traction methods for endoscopic submucosal dissection: What is the best traction method and traction direction?

Abstract

Endoscopic submucosal dissection (ESD) has been developed as a treatment for superficial gastrointestinal neoplasms, which can achieve en bloc resection regardless of the lesion size. However, ESD is technically difficult because endoscopists cannot bring their hand into the gastrointestinal tract, unlike surgeons in regular surgery. It is difficult to obtain sufficient tension in the dissection plane and a good field of vision. Therefore, ESD is associated with a long procedure time and a high risk of adverse events in comparison with endoscopic mucosal resection. Traction methods have been developed to provide sufficient tension for the dissection plane and a good field of vision during the ESD procedure. However, traction direction is limited in most traction methods, resulting in insufficient effect in some cases. Although traction direction is considered important, there have been few investigations of its effect. In the first half of this review, important traction methods are discussed, including traction direction. In second half, appropriate traction methods for each organ are considered. Other important considerations for traction method, such as ability to adjust traction strength, interference between traction device and endoscope, and the need for specialized devices are also discussed.

Proactive over reactive: the snare-based pretraction method improving the full-thickness resection of a large gastrointestinal stromal tumor

“…Although many traction strategies are used to assist endoscopic resection of submucosal tumors, these methods are mainly applied passively to provide traction from a certain direction or at a certain stage during the procedure 4 5 . Here, we adopted the active traction method with a snare being anchored to the tumor before the first incision.…”

Usefulness of the combined orthodontic rubber band and clip method for gastric endoscopic submucosal dissection

“…It has been reported that traction-assisted methods provide endoscopists with a better field of view of the submucosa, shortening the ESD duration and reducing its adverse events rate [ 5 ]. Therefore, various ESD traction methods continued to emerge in recent years [ 6 ], all showing advantages and disadvantages.…”

Usefulness of the combined orthodontic rubber band and clip method for gastric endoscopic submucosal dissection

“…It has been reported that traction-assisted methods provide endoscopists with a better eld of view of the submucosa, shortening the ESD duration and reducing its adverse events rate. 5 Therefore, various ESD traction methods continued to emerge in recent years, 6 all showing advantages and disadvantages. Our previous report showed that the combined orthodontic rubber band (ORB) and clip traction-assisted ESD achieved good results in colorectal tumors.…”