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

Abstract

Endoscopic submucosal dissection (ESD) is a well-established method for the treatment of early-stage gastrointestinal neoplasms. Adequate submucosal exposure is one of the most significant factors related to an effective and safe dissection. The aim of this systematic review was to evaluate the efficacy and safety of various methods that assist traction during ESD of precancerous and earlystage neoplastic lesions of the gastrointestinal tract. We performed an electronic search of the MEDLINE and the Cochrane Controlled Trials Register databases for relevant studies published up to May 2019. Trials exclusively recruiting patients undergoing ESD for superficial gastrointestinal cancer were considered eligible for inclusion. Thirty-three articles including 3,134 patients met the inclusion criteria. The studies evaluated different approaches for widening the endoscopic view, including magnetic anchor-guided ESD (3 studies), use of a second endoscope (5 studies), clip-involving technique (21 studies), and miscellaneous methods (4 studies). Among them, only 6 were randomized controlled trials evaluating different approaches. Overall, the implementation of methods that assist traction during ESD significantly improved the operating time and R0 resection rate and decreased the rate of complications (bleeding and perforation). Interventions that assist traction seem efficacious in improving tissue traction, thus facilitating ESD performance. Clin

Endoscopic diagnosis and treatment of gastric dysplasia and early cancer: Current evidence and what the future may hold

“…Generating counter-traction during ESD is of benefit in reducing procedural time and complications[ 166 , 167 ]. Depending on the position of the lesion being resected, gravity may not provide sufficient access to submucosal tissue planes.…”

Double-endoscope assisted endoscopic submucosal dissection for treating tumors in rectum and distal colon by expert endoscopists: a feasibility study

“…Widening of the submucosal space facilitating visualization and dissection of the submucosal layer during ESD can be achieved by traction, offering the potential to improve the speed and ease of submucosal dissection. Various advanced technology endoscopes, innovative devices i.e., DiLumen Endolumenal Interventional Platform (Lumendi Ltd., High Wycombe, UK) or ORISE TRS (Boston Scientific Corp, Marlborough, MA, USA), as well as techniques, i.e., clip-with-line or gravity, have been implemented in an effort to optimize traction during ESD and ultimately enhance the procedure`s performance [4]. Doubleendoscope assisted ESD (DEA-ESD) achieves traction using two separate endoscopes inserted into the lumen parallel to each other.…”

Novel Colorectal Endoscopic Submucosal Dissection With Double-Endoscope and Snare-Based Traction

“…Gravity, injection fluid, or a clip-with-line approach has been used to optimize traction during ESD to improve performance. 5 Nevertheless, ESD remains technically demanding, even with the use of these methods, and traction during ESD is still not satisfactory. The robotic system can offer an additional adjustable real-time traction, and the result is promising.…”