Snare combined with endoclips in endoscopic submucosal dissection with mucosal traction for gastroesophageal neoplasia

Abstract

Background and Aim Mucosal traction as a “second hand” in endoscopic submucosal dissection (ESD) is very helpful for ESD operators. The efficacy of using a snare combined with endoclips to assist in ESD (SC‐ESD) was evaluated whether it could achieve peroral external traction (PET) and peroral internal traction (PIT) and real‐time adjustment of mucosal traction position. This study aimed to preliminarily evaluate its feasibility. Methods A snare was fixed using endoclips to the incised mucosal flap that was intended for dissection. Subsequently, the snare was adjusted to achieve mucosal traction. This study included 54 gastroesophageal neoplasias in 54 consecutive patients who underwent SC‐ESD. The operative and clinical data were retrospectively collected. Results Peroral external tractions were performed for 22 esophageal neoplasias, and PETs and PITs were performed for 32 gastric neoplasias. The median (interquartile range) sizes of lesions were 4.3 (2.5) and 4.2 (2.1) cm, operation times were 73.4 (43.8) and 60.0 (45.2) min, and submucosal dissection times were 27.0 (32.0) and 31.0 (34.5) min in the esophagus and stomach, respectively. Mucosal traction position could be effectively adjusted by fixing the snare to the incised mucosal flap intended for dissection during SC‐ESD. All lesions in the esophagus and stomach were completely resected, with R0 resection rates of 100%. Besides postoperative bleeding in a patient with gastric neoplasia, no intraoperative and postoperative perforations occurred. Conclusions SC‐ESD seems to be feasible for resecting gastroesophageal neoplasia, and two types of mucosal tractions (PET and PIT) could be effectively achieved during SC‐ESD. Further prospective comparative study with a large sample is warranted.

Methods that Assist Traction during Endoscopic Submucosal Dissection of Superficial Gastrointestinal Cancers: A Systematic Literature Review

“…In keeping with the findings of those reports, the approach of inserting a selective snare along with the endoscope has also been shown to be safe and feasible in ESD of colonic and gastric intraepithelial neoplasia. 47,50 An alternative internal traction method using the S-O clip for treating colorectal lesions has been recommended. The device is advanced through the working channel of an endoscope and functions independently of endoscope movements.…”

“…All but 2 studies 38,46 were conducted in a single-site setting. Twenty-three had a prospective design [18][19][20][21][22][23]26,27,29,30,32,33,35,[37][38][39][40][41][44][45][46][47]50 and 10 had a retrospective design. 24,25,28,31,34,36,42,43,48,49 Among the prospective studies, 6 were randomized controlled trials (RCTs).…”

“…38,48 With respect to the traction method, 3 studies evaluated magnetic anchor-guided ESD (MA-ESD), 19,44,49 5 evaluated the efficacy of double endoscopes, 22,27,28,40,48 21 investigated clip-involving methods for applying traction, [24][25][26][29][30][31][32][33][34][35][36][37][38][39][41][42][43][45][46][47]50 and 4 assessed miscellaneous methods. 18,20,21,23 Concerning the anatomical location where ESD was performed, 6 studies evaluated ESD traction methods for esophageal lesions, 21,26,32,38,41,43 17 for stomach lesions, [18][19][20]23,25,[27][28][29]…”

Tumor traction techniques in intraluminal endoscopic surgery of the digestive tract

“…Qiang Zhang и соавт. описали два способа тракции с использованием петли и эндоскопических клипс: пероральная наружная и внутренняя тракция [44]. Пероральная наружная тракция включает следующие шаги: введение в подслизистый слой гиалуроновой кислоты; рассечение слизистой оболочки по периметру образования; фиксация петли, располагающейся параллельно эндоскопу, эндоскопической клипсой, проведенной через рабочий канал эндоскопа (клипсу использовали с функцией открытия и закрытия); доставка петли под эндоскопическим контролем в желудок и фиксация ее клипсой к краю рассеченной слизистой оболочки в нескольких местах; хорошая визуализация подслизистого слоя после затягивания петли.…”

Traction-assisted endoscopic submucosal dissection in the esophagus: Should we all be flossing?

“…A variation of the clip-line method has been described whereby a cold snare is substituted for the line to allow for bidirectional (pulling and pushing) traction to better expose the submucosa. 8 An extension of the clip-line method is the clip-line-clip (pulley) method, which provides a fulcrum that can be used to vary the amounts of traction and countertraction needed during various phases of the ESD by adjusting the tension of the line. 9 Published reports of the use of pulley-type traction mainly involve gastric ESD.…”