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

Uppal, Dushant; Wang, Andrew Y.

doi:10.1016/j.gie.2019.09.038

Cited by 3 publications

(4 citation statements)

References 19 publications

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“…Moreover, the subtle distinction between these words results in the potential for confusion. 34 Traction can be roughly classified into 3 categories (ie, vertical, proximal, and distal) based on the direction against the GI wall and the endoscope tip (Fig. 5).…”

Section: Discussionmentioning

confidence: 99%

Comparing a conventional and a spring-and-loop with clip traction method of endoscopic submucosal dissection for superficial gastric neoplasms: a randomized controlled trial (with videos)

Nagata

Fujikawa

Munakata

2021

Gastrointestinal Endoscopy

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Background and Aims: Several traction methods have sought to overcome the technical difficulties of endoscopic submucosal dissection (ESD). However, traction direction has remained limited in most of these methods, with lack of clarity about the optimal method and traction direction for gastric ESD. A spring-and-loop with clip (SLC) has been developed as a multidirectional traction device. Here, we investigated whether SLC tractionassisted ESD (SLC-ESD) improved procedure-related outcomes compared with conventional ESD (C-ESD) among patients with superficial gastric neoplasms. Methods: This single-center randomized controlled trial included patients with superficial gastric neoplasms undergoing SLC-ESD or C-ESD between October 2018 and December 2019. Using the multidirectional traction function, we set traction vertical to the gastric wall for SLC-ESD. The primary outcome was the median procedure time for gastric ESD. Results: The SLC-ESD and C-ESD groups comprised 40 patients each, and all the enrolled patients underwent the assigned treatment. The median ESD procedure time was significantly shorter in the SLC-ESD group (29.1 minutes) than in the C-ESD group (52.6 minutes; P Z .005). SLC had a mean attachment time of 1.82 minutes. En bloc resection was achieved without perforation in all the patients in both groups. Conclusions: Our findings suggest that SLC-ESD reduces gastric ESD procedure time without increasing the risk of perforation and that the vertical direction to the gastric wall is the appropriate traction direction for gastric ESD.

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Section: Discussionmentioning

confidence: 99%

Comparing a conventional and a spring-and-loop with clip traction method of endoscopic submucosal dissection for superficial gastric neoplasms: a randomized controlled trial (with videos)

Nagata

Fujikawa

Munakata

2021

Gastrointestinal Endoscopy

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“…In published literature of ESD, the terms traction and countertraction are used interchangeably; the unclear distinction results in a potential for confusion[ 12 ]. In this article, we do not use the term countertraction.…”

Section: Basics Of Tractionmentioning

confidence: 99%

Advances in traction methods for endoscopic submucosal dissection: What is the best traction method and traction direction?

Nagata¹

2022

WJG

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Endoscopic submucosal dissection (ESD) has been developed as a treatment for superficial gastrointestinal neoplasms, which can achieve en bloc resection regardless of the lesion size. However, ESD is technically difficult because endoscopists cannot bring their hand into the gastrointestinal tract, unlike surgeons in regular surgery. It is difficult to obtain sufficient tension in the dissection plane and a good field of vision. Therefore, ESD is associated with a long procedure time and a high risk of adverse events in comparison with endoscopic mucosal resection. Traction methods have been developed to provide sufficient tension for the dissection plane and a good field of vision during the ESD procedure. However, traction direction is limited in most traction methods, resulting in insufficient effect in some cases. Although traction direction is considered important, there have been few investigations of its effect. In the first half of this review, important traction methods are discussed, including traction direction. In second half, appropriate traction methods for each organ are considered. Other important considerations for traction method, such as ability to adjust traction strength, interference between traction device and endoscope, and the need for specialized devices are also discussed.

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“…To solve this issue, some reports have suggested the effectiveness of traction, such as clip-thread method 4 5 6 7 . However, the direction of traction is limited, and the traction direction is closer to the tangential direction as the lesion diameter increases.…”

Section: Introductionmentioning

confidence: 99%

“…To solve this issue, some reports have suggested the effectiveness of traction, such as clip-thread method [4][5][6][7]. However, the direction of traction is limited, and the traction direc-First clinical experience with esophageal ESD using a novel adjustable traction device Fax: +81-3-5363-3895 motohikokato@keio.jp ABSTR AC T Background and study aims In esophageal endoscopic submucosal dissection (ESD), the effectiveness of traction including clip-thread method has been reported, but it is difficult to adjust the direction of traction.…”

Section: Introductionmentioning

confidence: 99%

First clinical experience with esophageal ESD using a novel adjustable traction device

et al. 2023

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Background and study aims In esophageal endoscopic submucosal dissection (ESD), the effectiveness of traction including clip-thread method has been reported, but it is difficult to adjust the direction of traction. Therefore, we developed a dedicated over-tube type traction device (ENDOTORNADO) that has a working channel and allows traction from any directions by rotating itself. We investigated the clinical feasibility and potential usefulness of this new device in esophageal ESD. Patients and methods This is a single-center, retrospective study. Six cases of esophageal ESD with ENDOTORNADO from January to March 2022 (tESD group) were compared with 23 cases of conventional esophageal ESD performed by the same operator from January 2019 to December 2021 (cESD group) in terms of clinical treatment outcomes. Results In all cases, en bloc resection was achieved without intraoperative perforation. The total procedure speed was significantly increased in tESD group (23 vs. 30 mm2/min, p =0.046). In particular, the submucosal dissection time was significantly reduced to about one-quarter in tESD group (11 vs. 42 min, p =0.004). Conclusions ENDOTORNADO creates the adjustable traction from any directions and may have the clinical feasibility. It would be an option for human esophageal ESD.

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

Cited by 3 publications

References 19 publications

Comparing a conventional and a spring-and-loop with clip traction method of endoscopic submucosal dissection for superficial gastric neoplasms: a randomized controlled trial (with videos)

Comparing a conventional and a spring-and-loop with clip traction method of endoscopic submucosal dissection for superficial gastric neoplasms: a randomized controlled trial (with videos)

Advances in traction methods for endoscopic submucosal dissection: What is the best traction method and traction direction?

First clinical experience with esophageal ESD using a novel adjustable traction device

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