Recent traction methods for endoscopic submucosal dissection

Abstract

Endoscopic mucosal resection (EMR) is problematic with regard to en bloc and curable resection rates. Advancements in endoscopic techniques have enabled novel endoscopic approaches such as endoscopic submucosal dissection (ESD), which has overcome some EMR problems, and has become the standard treatment for gastrointestinal tumors. However, ESD is technically difficult. Procedure time is longer and complications such as intraoperative perforation and bleeding occur more frequently than in EMR. Recently various traction methods have been introduced to facilitate ESD procedures, such as clip with line, external forceps, clip and snare, internal traction, double scope, and magnetic anchor. Each method must be used appropriately according to the anatomical characteristics. In this review we discuss recently proposed traction methods for ESD based on the characteristics of various anatomical sites.

Updated evidence on endoscopic resection of early gastric cancer from Japan

“…Besides the double-endoscope method [4], various types of traction methods have been investigated without conclusive outcomes [35]. These techniques would be useful for complex lesions (e.g., fibrotic lesions) or difficult locations (e.g., greater curvature in the body, the fornix, prepylorus), and further clinical studies to reveal the appropriate application of the best methods are warranted.…”

Novel pre‐incision clip and traction method for colorectal endoscopic submucosal dissection

“…However, ESD in the thin‐walled colon and rectum is particularly difficult and presents a high risk for perforation. Various traction methods and devices have been reported to make ESD safer and easier . The current traction methods involve pulling the clip with a line or spring after mucosal incision followed by a certain amount of submucosal dissection.…”

“…traction methods and devices have been reported to make ESD safer and easier. [1][2][3] The current traction methods involve pulling the clip with a line or spring after mucosal incision followed by a certain amount of submucosal dissection. However, dissection of the submucosa immediately after the mucosal incision is challenging for lessexperienced endoscopists.…”

Colorectal endoscopic submucosal dissection: patient selection and special considerations

“…Patient position change to make optimal use of gravity is the most commonly employed method 106,107. A variety of innovations have been described to assist with traction, most involving endoscopic clips 108. One of the simplest and most cost-effective is the clip with line method 107,109.…”