Two traction methods that can facilitate esophageal endoscopic submucosal dissection

Area of Science:

• Gastroenterology
• Endoscopic Surgery

Background:

• Endoscopic submucosal dissection (ESD) is a crucial technique for resecting gastrointestinal neoplasms.
• Traction devices are essential for optimizing visualization and tension during ESD.
• Clip-with-line (CWL) is a commonly used traction device for per-oral traction.

Purpose of the Study:

• To compare the efficacy and safety of conventional ESD with CWL-assisted ESD (CWL-ESD) for large esophageal tumors.
• To identify risk factors for technical difficulties during esophageal ESD.
• To evaluate the utility of endoscopic submucosal tunnel dissection (ESTD) for complex esophageal lesions.

Main Methods:

• A multicenter randomized controlled trial (CONNECT-E trial) compared conventional ESD and CWL-ESD in Japan.
• Multivariate analysis identified risk factors for technical difficulties.
• A randomized controlled trial and propensity score matching analysis in China evaluated ESTD versus conventional ESD for specific esophageal tumor types.

Main Results:

• CWL-ESD demonstrated a shorter procedure time compared to conventional ESD without increased adverse events.
• Whole-circumferential and abdominal esophageal lesions were independent risk factors for technical difficulties.
• ESTD showed significantly reduced procedure times for lesions covering ≥ 1/2 of the esophageal circumference and for esophagogastric junction lesions compared to conventional ESD.

Conclusions:

• CWL-assisted ESD is an effective and safe method for large esophageal tumors, reducing procedure time.
• ESTD is a valuable alternative for complex esophageal lesions, enhancing efficiency and safety.
• The judicious application of CWL-ESD and ESTD, potentially in combination, can optimize esophageal ESD outcomes.