Endoscopic intermuscular dissection of rectal T1 cancer with adaptive traction: use of additional loops to improve traction directly on the circular muscular layer

Masgnaux, Louis-Jean; Yzet, Clara; Rivory, Jérôme; Wallenhorst, Timothée; Legros, Romain; Jacques, Jérémie; Pioche, Mathieu

doi:10.1055/a-2011-5546

Cited by 4 publications

(5 citation statements)

References 5 publications

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“…In addition, the high traction provided by this device means that dissection indications can be extended to technically difficult lesions [57][58][59][60][61][62], exposing even the thinnest submucosal layers, as in appendicular lesions [63], diverticular lesions [64], on an anterior resection site [59,65,66], or in the duodenum or the ileocecal valve. The high traction force also enables the endoscopist to be as close as possible to the muscle, in cases where a deep R0 resection is essential, such as T1 rectal lesions or neuroendocrine tumor [67] whatever the technique chosen between ESD and endoscopic intermuscular dissection [68]. The use of this device makes the start of the procedure more complex as the attachment loops of the traction device are smaller than conventional spider traction loops, but allow an adaptive traction force to be obtained, responding to the needs of the operator in real-time.…”

Section: -Conventional Internal Tractionmentioning

confidence: 99%

Technical Advances in Endoscopic Resection Techniques for Lower GI Malignancies

Masgnaux,

Grimaldi,

Jacques

et al. 2024

Visc Med

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Background: The management of bulky neoplastic lesions in the digestive tract has historically been a surgical pursuit. With advancements in endoscopic techniques, particularly endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), a paradigm shift toward organ preservation has been initiated. These endoscopic methods, developed incrementally since the 1980s, have progressively enabled curative management of lesions with minimal morbidity, challenging the previously unchallenged domain of surgery. Summary: This review traces the evolution of endoscopic resection from snare polypectomy and EMR to sophisticated ESD, highlighting the technological innovations that have expanded the scope of endoscopic resection. It discusses the intricacies of various EMR techniques like underwater EMR, anchoring EMR, and hybrid EMR, alongside traction-assisted methods and the use of viscous solutions for submucosal injection. Additionally, the manuscript delves into the advancements in ESD, emphasizing traction strategies, knife technology, and the optimization of endoscopes. The benefits of these advancements are weighed against the challenges in anatomopathological interpretation posed by piecemeal resections. Key Messages: The continuous amelioration of endoscopic resection techniques has significantly improved the outcomes of digestive tract lesion management, particularly in achieving R0 resections and reducing recurrence rates. These advancements represent a monumental step toward minimizing the invasiveness of lesion management. However, despite the progress, the necessity for early follow-up post-EMR remains due to the non-negligible recurrence rates, underscoring the need for a rigorous postoperative surveillance regimen. Furthermore, our review suggests that while ESD has transformed the therapeutic landscape, its widespread adoption hinges on further simplification, safety enhancement, and acceleration of the procedure, possibly through innovations like adaptive traction devices.

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Section: -Conventional Internal Tractionmentioning

confidence: 99%

Technical Advances in Endoscopic Resection Techniques for Lower GI Malignancies

Masgnaux,

Grimaldi,

Jacques

et al. 2024

Visc Med

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“…But the R0 resection rate for these T1 cancers could be improved on the vertical margin. Although endoscopic intermuscular dissection has recently been described as a method of achieving free vertical margins by dissecting more deeply in the rectum 2 , this approach is not feasible in the colon where the two muscular layers are thin. To facilitate exposure of the submucosal space, which is often very thin when it remains, an adaptive traction device that is capable of being tightened to increase traction during the late stages of the procedure (A-TRACT-2; Hospices Civils de Lyon, France) could be useful 3 4 .…”

Section: Figmentioning

confidence: 99%

Multipolar adaptive traction allows diagnostic endoscopic submucosal dissection for colonic lesions with focal invasive area

Lafeuille,

Masgnaux,

Wallenhorst

et al. 2023

Endoscopy

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“…EID was chosen as the preferred approach given the tumor's location and potential depth (▶ Video 1). For effective visualization during EID, the A-TRACT-2 + 2 adaptive traction device was utilized [4,5] (▶ Fig. 2).…”

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confidence: 99%

Endoscopic intermuscular dissection of an undetermined submucosal lesion with adaptive traction to obtain a free vertical margin

Masgnaux,

Grimaldi,

Hervieu

et al. 2024

Endoscopy

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Endoscopic intermuscular dissection of rectal T1 cancer with adaptive traction: use of additional loops to improve traction directly on the circular muscular layer

Cited by 4 publications

References 5 publications

Technical Advances in Endoscopic Resection Techniques for Lower GI Malignancies

Technical Advances in Endoscopic Resection Techniques for Lower GI Malignancies

Multipolar adaptive traction allows diagnostic endoscopic submucosal dissection for colonic lesions with focal invasive area

Endoscopic intermuscular dissection of an undetermined submucosal lesion with adaptive traction to obtain a free vertical margin

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