Device-assisted traction methods in colorectal endoscopic submucosal dissection and options for difficult cases

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Medical Devices

Background:

• Endoscopic submucosal dissection (ESD) is challenging in the colorectum due to technical difficulties like poor visualization and inadequate tissue tension.
• Traction devices aim to improve the visual field and tension during ESD, potentially reducing procedure time and complications.
• Previous studies suggested traction devices reduce colorectal ESD time, but were limited by single-center designs.

Purpose of the Study:

• To evaluate the efficacy of traction device-assisted ESD (T-ESD) compared to conventional ESD (C-ESD) for colorectal tumors in a multicenter setting.
• To assess the impact of T-ESD on procedure time, particularly for large lesions or procedures performed by nonexpert operators.

Main Methods:

• The CONNECT-C trial, a multicenter randomized controlled trial, compared C-ESD with T-ESD for colorectal tumors.
• T-ESD utilized various traction methods at the operator's discretion (S-O clip, clip-with-line, clip pulley).
• The primary endpoint was the median ESD procedure time.

Main Results:

• The median ESD procedure time was not significantly different between T-ESD and C-ESD groups.
• T-ESD showed a trend towards shorter procedure times for lesions ≥ 30 mm and in cases performed by nonexpert operators.
• No significant difference in perforation rates or other complications was mentioned in the abstract.

Conclusions:

• Traction device-assisted ESD did not significantly reduce overall colorectal ESD procedure time in this multicenter trial.
• T-ESD may be beneficial for specific scenarios, including larger colorectal lesions and procedures performed by less experienced endoscopists.
• Alternative or combined techniques like balloon-assisted endoscopy or underwater ESD may offer further improvements for colorectal ESD challenges.