Application of in vivo traction-assisted resection of proximal colon lesions: a case series (with video)

Zhang, Aijun; Song, Yanjun; Cui, Xiang-Dan; Li, Ruyuan

doi:10.1007/s00464-022-09266-y

Cited by 4 publications

(5 citation statements)

References 22 publications

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“…In the present study, the results showed that despite being statistically insignificant, the dissection time and dissection speed were improved when using elastic ring traction, and ESD with traction group had higher en bloc resection and R0 resection rates than conventional ESD group without traction. Of note, the traction group has lower overall complication rate and lower perforation rate than those in the conventional group, and the differences are statistically significant, which provides more evidence that in vivo traction in resecting proximal colonic tumors is effective and safe [ 13 , 14 ]. Besides, the immediate bleeding rate was lower in the traction group than conventional ESD group, despite of the statistical insignificance.…”

Section: Discussionmentioning

confidence: 99%

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ESD with elastic ring traction is more effective and safer than conventional ESD in large proximal colon neoplastic lesions: a retrospective cohort study (with video)

Yinhe,

Yang,

Aijun

et al. 2023

Surg Endosc

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Background and aims Colorectal endoscopic submucosal resection (ESD), especially ESD in proximal colon, has always been challenging. We invented a novel elastic ring as a traction method to facilitate ESD. Our study aims to compare the safety and effectiveness of ESD with in vivo traction and conventional ESD without traction in the treatment of large proximal colon neoplastic lesions. Methods This retrospective cohort study included consecutive patients with large (≥ 20 mm in their maximal diameter) proximal colon neoplastic lesions who underwent ESD with in vivo elastic ring traction or conventional ESD without traction in our endoscopy center between June 2018 and April 2022 by one experienced endoscopist. Results The ESD with traction group has lower overall complication rate and lower perforation rate than those in the conventional ESD group (0% vs 14.71%, P = 0.021; 0% vs 11.76%, P = 0.048, respectively), and the differences are statistically significant. Although there are no significant differences in the rates of en bloc resection and R0 resection and bleeding rate, ESD with traction group still had higher en bloc resection and R0 resection rates and lower bleeding rate than conventional ESD group without traction (100% vs 94.12%, P = 0.226; 94.59% vs 85.29%, P = 0.189, 8.82% vs 2.70%, P = 0.276, respectively). Conclusion ESD with elastic ring traction is potentially more effective and safer than conventional ESD in the treatment of large proximal colon neoplastic lesions. Further large, prospective controlled studies are needed to fully evaluate this novel method.

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Section: Discussionmentioning

confidence: 99%

“…Recently, we reported a case series which proved ESD with elastic ring traction is effective and safe in proximal colon neoplastic lesions [ 13 ]. There are several studies which involve ESD in proximal colon; however, they are mainly ex vivo study or feasibility study [ 14 , 15 ].…”

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confidence: 99%

ESD with elastic ring traction is more effective and safer than conventional ESD in large proximal colon neoplastic lesions: a retrospective cohort study (with video)

Yinhe,

Yang,

Aijun

et al. 2023

Surg Endosc

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“…It is important to note that our study specifically focused on precancerous lesions and colon cancer cases with limited depth of mucosal or submucosal infiltration (<1000 µm). successfully utilized their elastic rings in completing ESD of proximal colon lesions [13] . Double elastic rings traction has demonstrated the ability to provide improved exposure of the submucosal layer, expedite the dissection process, and reduce complications, particularly for large proximal colon lesions.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic submucosal dissection of colorectal lesions assisted with double elastic rings：a case series

Sun,

Zhai,

Zhang

et al. 2023

Preprint

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Background: Endoscopic submucosal dissection (ESD) has become the preferred treatment for early mucosal lesions in the gastrointestinal tract. A clear surgical field of view is crucial for the safety of endoscopic surgery. The development of various traction technologies has simplified the procedure, reduced operation time, and decreased the occurrence of adverse events. Double elastic rings traction is particularly effective in exposing the submucosal layer, expediting the dissection process, and reducing complications, especially for large lesions in the proximal colon. Methods: This retrospective study included patients with colorectal lesions who underwent ESD treatment at Qilu Hospital of Shandong University from January 2021 to June 2023. The selection of patients was based on the use of the double elastic rings traction method during the operation. Data regarding lesion location, dissection time, resection speed, pathological analysis, complications, secondary surgery, R0 resection, and curative resection were retrospectively analyzed. Results: The study consisted of 10 patients. The average maximum diameter of the specimens was 43±11mm, with a procedure duration and resection speed of 19.77±5.11mm^2/min, respectively. All lesions were completely resected in a single attempt, and there were no instances of wound perforation or delayed hemorrhage. One patient required secondary surgery, and another received hematology treatment. Eight lesions achieved R0 resection and curative resection. Conclusion: The use of double elastic rings traction during ESD can provide a wider field of view and reduce complications. Therefore, double elastic rings traction should be considered for the management of large colorectal lesions.

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“…ESD surgery uses traction technology to maximize the operator’s surgical field of view while enhancing safety and clinical efficacy[ 9 ]. Various kinds of traction aids exist; however, the novel elastic traction ring is becoming more popular[ 10 , 11 ]. Because these rings are new, their application and function require additional study.…”

Section: Discussionmentioning

confidence: 99%

Gastric ulcer treated using an elastic traction ring combined with clip: A case report

Pang¹,

Song²,

Sikong³

et al. 2022

World J Clin Cases

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BACKGROUND There is a high annual incidence of acute, nonvariceal upper gastrointestinal bleeding in Chinese adults. Early endoscopic intervention can reduce rates of rebleeding, surgery, and mortality. The metal clip is the most common method for establishing homeostasis; however, it possesses several limitations. In patients with bleeding secondary to large gastric ulcers, the clip will often fail to stop the bleeding. This article highlights the use of an elastic traction ring as a novel hemostatic method for patients with upper gastrointestinal bleeding. CASE SUMMARY An elderly male presented to the emergency room with complaints of hematemesis and melena. Endoscopic examination revealed an ulcer (Forrest IIa) in the lesser curvature of the gastric antrum. Six tissue clips and one elastic traction ring were inserted into the stomach cavity to suture the ulcer. The patient recovered quickly without postoperative gastrointestinal bleeding. Two months later, the patient's ulcer was significantly healed. CONCLUSION To our best knowledge, this is the first report to demonstrate the safety and efficacy of elastic traction rings for upper gastrointestinal bleeding. Elastic traction rings should be considered a routine therapeutic modality for patients with upper gastrointestinal bleeds.

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Application of in vivo traction-assisted resection of proximal colon lesions: a case series (with video)

Cited by 4 publications

References 22 publications

ESD with elastic ring traction is more effective and safer than conventional ESD in large proximal colon neoplastic lesions: a retrospective cohort study (with video)

ESD with elastic ring traction is more effective and safer than conventional ESD in large proximal colon neoplastic lesions: a retrospective cohort study (with video)

Endoscopic submucosal dissection of colorectal lesions assisted with double elastic rings：a case series

Gastric ulcer treated using an elastic traction ring combined with clip: A case report

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