Efficacy of a Traction Device for Endoscopic Submucosal Dissection Using a Scissor-Type Knife: A Randomized Controlled Trial

Abstract

INTRODUCTION:Although safe, colorectal endoscopic submucosal dissection (ESD) using a scissor-type knife has a slow resection speed. We aimed to evaluate the efficacy of a traction device to hasten the resection speed.METHODS:This multicenter randomized controlled trial was conducted at 3 Japanese institutions. Patients with a 20–50-mm superficial colorectal tumor were enrolled and randomly assigned to a conventional-ESD (C-ESD) group or a traction-assisted ESD (T-ESD) group. The primary outcome was the resection speed.RESULTS:The C-ESD and T-ESD groups comprised 49 and 48 patients, respectively. Although the mean resection speed was not significantly different in the entire cohort between the groups (23.7 vs 25.6 mm2/min, respectively; P = 0.43), it was significantly faster with T-ESD than with C-ESD at the cecum (32.4 vs 16.7 mm2/min, respectively; P = 0.02). The mean resection speed of tumors ≥30 mm tended to be faster by T-ESD than by C-ESD (34.6 vs 27.8 mm2/min, respectively; P = 0.054). The mean procedure time of T-ESD was significantly shorter than that of C-ESD (47.3 vs 62.3 minutes, respectively; P = 0.03). The en bloc (100% vs 100%), complete (98.0% vs 97.9%), and curative resection (93.9% vs 91.7%) rates were similar between the 2 groups. Perforation and delayed hemorrhage occurred in only 1 patient each in the T-ESD group.DISCUSSION:Although the resection rates were sufficiently high and adverse event rates were extremely low in both the groups, the use of a traction device for ESD in the proximal colon and for large lesions may increase the resection speed.

Endoscopic Submucosal Dissection of a Large Rectal Lesion by Using a Novel Traction Device to Facilitate Traction Adjustments

“…Comparison of submucosal dissection speed using different traction devices Suzuki et al3 Tamaru et al4 Our cases aAbbreviations: ET-M-loop, Easy Traction-adjustments M-loop; SD, standard deviation; SDS, submucosal dissection speed; SE, standard error. a Traction adjustments during submucosal dissection were performed in all cases.…”

“…In recent years, the usefulness of countertraction with the use of traction devices has been widely reported in colorectal ESD. 3,4 However, large lesions or lesions located in the flexure of the colorectum often do not provide sufficient countertraction. The ET-M-loop not only allows for multiple traction adjustments, but also allows for smooth traction adjustments by reducing the size of the center loop.…”

Traction-assisted versus conventional endoscopic submucosal dissection for superficial gastrointestinal neoplasms: a systematic review and meta-analysis of randomized controlled trials

“…The subgroup analysis by lesion site showed that there were significant differences between the subgroups only in terms of procedure time – where the duration of T-ESD was shorter than C-ESD only for colorectal (MD -24.74 minutes; 95% CI -36.22, -13.27; p<0.01; I 2 =72%) and esophageal (MD -17.77 minutes; 95% CI -22.81, -12.73; p<0.01; I 2 =0%) lesions; while the duration of stomach lesions dissection was similar between both techniques. 1 2 3 4 5 6 7 8 9 10 11 12 13 14…”