Optimal traction direction in traction-assisted gastric endoscopic submucosal dissection

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Medical Devices

Background:

• Endoscopic submucosal dissection (ESD) requires traction devices for optimal visualization and tension.
• Few large-scale studies evaluate traction device efficacy in gastric ESD.
• Clip-with-line (CWL) is a commonly used traction device for gastric ESD.

Purpose of the Study:

• To compare conventional ESD with CWL-assisted ESD (CWL-ESD) for superficial gastric neoplasms.
• To assess the impact of CWL on gastric ESD procedure time.
• To investigate the influence of lesion location on CWL effectiveness.

Main Methods:

• The CONNECT-G trial was a multicenter randomized controlled trial.
• Compared conventional ESD with CWL-ESD for superficial gastric neoplasms.
• Subgroup analysis based on lesion location (anterior/posterior walls, lesser/greater curvatures, upper/middle/lower thirds).

Main Results:

• No significant difference in overall gastric ESD procedure time between conventional ESD and CWL-ESD.
• Significant reduction in procedure time for CWL-ESD in lesions located on the greater curvature of the middle and upper stomach.
• Traction direction of CWL was limited and varied by lesion location.

Conclusions:

• The effectiveness of CWL in gastric ESD is influenced by lesion location and achievable traction direction.
• CWL-assisted ESD may offer time-saving benefits for specific gastric lesion locations.
• Further research is needed to determine optimal traction strategies for gastric ESD.