Multiloop as a novel traction method in accelerating colorectal endoscopic submucosal dissection

Suzuki, Yuichiro; Tanuma, Tokuma; Nojima, Masanori; Sudo, Gota; Akahonai, Masakazu; Hamamoto, Hidetaka; Aoki, Hironori; Harada, Taku; Katanuma, Akio; Nakase, Hiroshi

doi:10.1016/j.gie.2019.08.042

Cited by 23 publications

(28 citation statements)

References 17 publications

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“…3). All patients in the M-loop group are the same group of patients included in our previously published article on the M-loop method [10]. Eighty percent of the operators participating in this study were non-experts.…”

Section: Resultsmentioning

confidence: 99%

“…Undesired outcome, n (%) 3 (6.0 %) 19 (16.5 %) 0.083 ▶ Table 5 Differences in average SDS (mm 2 /min) between the M-loop and non-traction groups in experts and non-experts. As we already have reported [9,10], the M-loop can be made easily in a few minutes with readily available surgical thread and clip. Our data indicate that attachment time to the lesion with the M-loop (approximately 2 minutes, 54 seconds) was similar to that with S-O clip for colorectal lesions (2 minutes).…”

Section: M-loop (N = 50)mentioning

confidence: 99%

“…To facilitate colorectal ESD by ESD non-experts, we previously reported use of a more accessible and cost-effective traction technique, called the multiloop (M-loop) method, which can done with only surgical sutures and a clip [9,10]. In this retrospective observational study, we investigated the dissection speed of the M-loop method for colorectal ESD in comparison with non-traction methods including PCM and the conventional method.…”

Section: Comparison Of Dissection Speed During Colorectal Esd Betweenmentioning

confidence: 99%

“…M-loop was created and used in the same manner as previously reported [9,10]. A 3-0 silk suture thread (Sterilized Matsuda Suture; Matsuda) was reeled once around a 2.5-cc syringe and a knot was made.…”

Section: M-loop Designmentioning

confidence: 99%

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Comparison of dissection speed during colorectal ESD between the novel Multiloop (M-loop) traction method and ESD methods without traction

et al. 2020

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Background and study aims We previously reported on a novel traction method called Multiloop (M-loop) for faster colorectal endoscopic submucosal dissection (ESD). In this study, we retrospectively compared the difference in submucosal dissection time (SDT), and submucosal dissection speed (SDS) between groups of patients who were treated using traction with the M-loop method, and with non-traction methods of colorectal ESD. Patients and methods We reviewed and timed duration of colorectal ESD by the non-traction method from videos recorded between June 2016 and December 2017. From January 2018 onward, we used the M-loop method during all colorectal ESDs and timed it until August 2018. Outcomes of colorectal ESD with the M-loop method and non-traction methods were compared. The study involved two experts and eight non-experts and was carried out at a tertiary endoscopic center in Japan. Results The study included 50 patients who treated with the M-loop method and 115 patients treated with the non-traction method. Submucosal dissection time (SDT) was not significantly different (M-loop group, 42.1 ± 4.2 min, non-traction ESD group, 51.9 ± 3.3 min) (P = 0.098), but submucosal dissection speed (SDS) was significantly greater (M-loop group, 28.0 ± 2.9 mm2 /min, non-traction ESD group, 19.9 ± 2.0 mm2/min) (P = 0.0014) in the M-loop method group. Multivariate analysis showed that the M-loop method increased SDS by odds ratio of 1.46 (P = 0.001) when compared to the non-traction ESD method. A significant difference was also observed for SDT and SDS when the two methods were compared after propensity score matching (P = 0.001). No differences in unfavorable outcomes were observed. Conclusions The M-loop method improved SDS compared to non-traction methods of ESD. The method is an effective tool to assist colorectal ESD.

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Section: Resultsmentioning

confidence: 99%

Section: M-loop (N = 50)mentioning

confidence: 99%

Section: Comparison Of Dissection Speed During Colorectal Esd Betweenmentioning

confidence: 99%

Section: M-loop Designmentioning

confidence: 99%

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Comparison of dissection speed during colorectal ESD between the novel Multiloop (M-loop) traction method and ESD methods without traction

et al. 2020

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“…In countries where the SLC is not available, other traction devices that allow the traction direction to be controlled vertical to the GI wall might be used as an alternative. Such traction devices include ring thread, 39 multiloop, 40 double clip and rubber band, 41 and clip-band devices, 42 which uses a thread or a band instead of a spring. However, these devices are usually utilized in colorectal ESD.…”

Section: Discussionmentioning

confidence: 99%

Comparing a conventional and a spring-and-loop with clip traction method of endoscopic submucosal dissection for superficial gastric neoplasms: a randomized controlled trial (with videos)

Nagata

Fujikawa

Munakata

2021

Gastrointestinal Endoscopy

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Background and Aims: Several traction methods have sought to overcome the technical difficulties of endoscopic submucosal dissection (ESD). However, traction direction has remained limited in most of these methods, with lack of clarity about the optimal method and traction direction for gastric ESD. A spring-and-loop with clip (SLC) has been developed as a multidirectional traction device. Here, we investigated whether SLC tractionassisted ESD (SLC-ESD) improved procedure-related outcomes compared with conventional ESD (C-ESD) among patients with superficial gastric neoplasms. Methods: This single-center randomized controlled trial included patients with superficial gastric neoplasms undergoing SLC-ESD or C-ESD between October 2018 and December 2019. Using the multidirectional traction function, we set traction vertical to the gastric wall for SLC-ESD. The primary outcome was the median procedure time for gastric ESD. Results: The SLC-ESD and C-ESD groups comprised 40 patients each, and all the enrolled patients underwent the assigned treatment. The median ESD procedure time was significantly shorter in the SLC-ESD group (29.1 minutes) than in the C-ESD group (52.6 minutes; P Z .005). SLC had a mean attachment time of 1.82 minutes. En bloc resection was achieved without perforation in all the patients in both groups. Conclusions: Our findings suggest that SLC-ESD reduces gastric ESD procedure time without increasing the risk of perforation and that the vertical direction to the gastric wall is the appropriate traction direction for gastric ESD.

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Effectiveness of a novel traction device in endoscopic submucosal dissection for colorectal lesions

Liu

Wang

et al. 2022

Surg Endosc

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Background Among all types of superficial gastrointestinal (GI) neoplasms, colorectal lesions are recognized as one of the most difficult locations to operate, due to the limited operation space, physiological bends, poor visualization of the submucosal dissection plane sheltered by colorectal crinkle wall, and the thin intestinal mucosa layer which is easy to perforation. The purpose of this prospective study is to evaluate the feasibility, efficacy, and safety of a novel endoscopic traction technique in assisting the endoscopic submucosal dissection (ESD) procedure in colorectal lesions. Method A total of 117 patients with colonic lesions who underwent endoscopic treatment were enrolled between August 2020 and January 2021 at the endoscopic center of Beijing Chao-yang Hospital of Capital Medical University. Based on whether traction device was used during the operation, 60 and 57 patients were assigned to the conventional ESD group and clips and rubber band triangle traction-assisted ESD group (CRT-ESD, in which three clips and a rubber band were used to form an elastic triangular traction device), respectively. The total procedure time (TPT), submucosal dissection time (SDT), submucosal dissection speed (SDS), and rate of adverse events of the two groups were analyzed. Results After excluding patients who did not undergo treatment (conventional ESD, 1; CRT-ESD, 4), 112 patients were included in the study (conventional ESD, 59; CRT-ESD, 53). The baseline characteristics of the patients were well balanced between the two groups. The TPT (58.71 ± 26.22 min vs 33.58 ± 9.88 min, p < 0.001) and SDT (49.24 ± 23.75 min vs 26.34 ± 8.75 min, p < 0.001) were significantly different between the conventional ESD group and CRT-ESD group. The CRT-ESD group had significantly higher SDS than that of the traditional ESD group (0.54 ± 0.42 cm2/min vs 0.89 ± 0.40 cm2/min, p < 0.001). There were 4 (6.8%) cases of perforation in the traditional ESD group, and no perforation occurred in traction-assisted ESD. Conclusions Compared with traditional ESD, CRT-ESD with clip and rubber band is both safer and more effective in the treatment of colorectal lesions. Graphical abstract

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Multiloop as a novel traction method in accelerating colorectal endoscopic submucosal dissection

Cited by 23 publications

References 17 publications

Comparison of dissection speed during colorectal ESD between the novel Multiloop (M-loop) traction method and ESD methods without traction

Comparison of dissection speed during colorectal ESD between the novel Multiloop (M-loop) traction method and ESD methods without traction

Comparing a conventional and a spring-and-loop with clip traction method of endoscopic submucosal dissection for superficial gastric neoplasms: a randomized controlled trial (with videos)

Effectiveness of a novel traction device in endoscopic submucosal dissection for colorectal lesions

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