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Multipoint adjustable traction for endoscopic submucosal dissection using a helix tack suturing system: a case

Kambiz S Kadkhodayan1, Shayan Irani2, Saurabh Chandan1

  • 1Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA.

Videogie : an Official Video Journal of the American Society for Gastrointestinal Endoscopy
|July 11, 2025
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Summary

A new multipoint traction technique using the X-Tack Endoscopic Helix Tacking System improves submucosal visualization and lesion stability during endoscopic submucosal dissection (ESD). This method enhances colorectal ESD procedures.

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Area of Science:

  • Gastroenterology
  • Endoscopic Surgery

Background:

  • Optimal submucosal plane exposure is critical for effective endoscopic submucosal dissection (ESD).
  • Existing traction techniques often use nonadaptive single-point fixation, limiting visualization and efficiency.

Purpose of the Study:

  • To introduce and evaluate a novel multipoint, adjustable traction technique for colorectal endoscopic submucosal dissection (ESD).

Main Methods:

  • A new technique utilizing the X-Tack Endoscopic Helix Tacking System was developed.
  • Three tacks were placed around the lesion, and a fourth secured to the contralateral colon wall.
  • Pulling a polypropylene suture created multipoint traction, achieving a "parachuting effect" for enhanced submucosal exposure.

Main Results:

  • The novel traction technique was successfully applied in three patients undergoing colorectal ESD.
  • This method demonstrated improved lesion stability and submucosal visualization.

Conclusions:

  • Multipoint adjustable traction with the helix tack system enhances submucosal visualization, lesion stability, and adaptability during ESD.
  • Further research is warranted to validate this technique in a broader patient population.