Efficacy of Current Traction Techniques for Endoscopic Submucosal Dissection

Abstract

This systematic review aimed to assess the efficacy of the current approach to tissue traction during the endoscopic submucosal dissection (ESD) of superficial esophageal cancer, early gastric cancer, and colorectal neoplasms. We performed a systematic electronic literature search of articles published in PubMed and selected comparative studies to investigate the treatment outcomes of tractionassisted versus conventional ESD. Using the keywords, we retrieved 381 articles, including five eligible articles on the esophagus, 13 on the stomach, and 12 on the colorectum. A total of seven randomized controlled trials and 23 retrospective studies were identified. Clip line traction and submucosal tunneling were effective in reducing the procedural time during esophageal ESD. The efficacy of traction methods in gastric ESD varied in terms of the devices and strategies used depending on the lesion location and degree of submucosal fibrosis. Several prospective and retrospective studies utilized traction devices without the need to reinsert the colonoscope. When pocket creation is included, the traction devices and methods effectively shorten the procedural time during colorectal ESD. Conclusions: Although the efficacy is dependent on the organ and tumor locations, several traction techniques have been demonstrated to be efficacious in facilitating ESD by maintaining satisfactory traction during dissection. (Gut Liver,

High prevalence of musculoskeletal symptoms and injuries in third space endoscopists: an international multicenter survey

“…A major step would be to drastically change the physical structure of the endoscope which has not changed despite the emergence of newer endoscopic procedures which are considerably different from diagnostic upper endoscopies and colonoscopies, for which the endoscope was originally designed. In addition, modifications to the endoscope and endoscopic accessories such as multibending endoscopes, traction devices, and the recently available double balloon endoluminal interventional platform could also improve the efficiency of these rather long procedures and help decrease the risk of potential injury associated with them 20 21 22 .…”

The pocket-creation method facilitates endoscopic submucosal dissection of gastric neoplasms involving the pyloric ring

“…Further, retroflexion requires a slim endoscope with a small working channel that restricts the kind of devices that can be introduced. A traction device such as the clip-and-line method has been reported to overcome these difficulties 3 . However, traction cannot facilitate opening the submucosal layer in the duodenum, because it cannot compress the pyloric sphincter but just pulls the lesion.…”

Colonic endoscopic submucosal dissection – increasing attraction with improved traction?

“…nique (S-O clip method, ring-shaped thread countertraction method, clip and thread method). All studies showed comparable success rates but with significant shortening of the procedure time compared with the standard ESD technique [4]. Nomura et al described a single-clip traction method in combination with the pocket creation method without using a line [5].…”