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Endoscopic submucosal dissection with adaptive traction strategy: first prospective multicenter study (with video).

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The ATRACT device enhances colorectal endoscopic submucosal dissection (ESD) by maintaining traction, leading to faster and safer resections. This prospective study confirms its efficacy in clinical practice.

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Area of Science:

  • Gastroenterology
  • Endoscopic Surgery
  • Medical Devices

Background:

  • Traction is standard for colorectal endoscopic submucosal dissection (ESD), but traction force diminishes during procedures.
  • The ATRACT device employs a pulley system to sustain traction, aiming to improve ease and speed of ESD.
  • Previous retrospective data suggested efficacy and safety; this study aimed to prospectively validate these findings.

Purpose of the Study:

  • To prospectively evaluate the efficacy and safety of the ATRACT traction device in colorectal endoscopic submucosal dissection (ESD).
  • To assess the impact of the ATRACT device on resection speed and procedural outcomes.
  • To confirm initial findings from a retrospective study in a multicenter setting.

Main Methods:

  • A prospective multicenter study involving 5 experienced endoscopists.
  • Consecutive performance of 50 colorectal ESDs using the ATRACT device for lesions measuring 4-10 cm.
  • Exclusion of complex lesions (recurrent, appendiceal, ileocecal valve, etc.).

Main Results:

  • 50 ESDs were performed with a mean lesion diameter of 66.6 mm and surface area of 3066 mm².
  • Mean operating time was 55.2 minutes, achieving a mean resection speed of 61.4 mm²/min.
  • En bloc and R0 resection rates were 100% and 98%, respectively, with a 94% curative resection rate. Four perforations (8%) were endoscopically managed; one delayed hemorrhage (2%) occurred.

Conclusions:

  • The ATRACT device facilitates high-speed colorectal ESD, confirming its efficacy and safety in this prospective evaluation.
  • The adaptive traction strategy with the ATRACT device demonstrates superior resection speeds compared to previous techniques.
  • Further validation in larger cohorts and non-expert centers is warranted.