Hemoclip-suture-rubber band traction improves efficiency of colonic ESD: a randomized controlled trial

The objective of this study was to evaluate the efficacy and safety of a novel, simple internal traction method using a hemoclip, suture, and rubber band during endoscopic submucosal dissection (ESD) for colonic lesions.

A total of 96 patients undergoing ESD at Jiangyin Hospital Affiliated with Nantong University between January 2021 and December 2024 were randomized into two groups: Group A (n = 48) underwent conventional ESD, while Group B (n = 48) underwent ESD with hemoclip-suture-rubber band traction. The study included patients with early stage colon cancer, precancerous lesions (e.g., adenomas with high-grade dysplasia), and neuroendocrine tumors. Outcome measures included total procedure time, mucosal dissection time, number of submucosal injections, en bloc resection rate, adverse events, and the size of lesion area.

The hemoclip-suture-rubber band traction group (Group B) demonstrated significantly shorter total procedure time (72.63 ± 34.14 min versus 85.13 ± 38.18 min, P < 0.05) and mucosal dissection time (53.56 ± 29.03 min versus 71.63 ± 39.18 min, P < 0.001) compared with the conventional ESD group (Group A). Group B also required significantly fewer submucosal injections (1.63 ± 1.23 versus 4.75 ± 1.62, P < 0.001). Lesions in Group B were significantly larger (7.650 [2.857, 10.386] cm² versus 4.895 [2.062, 6.774] cm², P < 0.05). There were no statistically significant differences in en bloc resection rate or adverse events between the two groups (P > 0.05). However, in Group B, two patients experienced intraoperative muscularis propria injury (2/48, 4.2%) and presented with postoperative abdominal pain.

The hemoclip-suture-rubber band traction technique facilitates colonic ESD by reducing procedure time and the need for submucosal injections, especially in larger lesions.While overall safety is comparable to conventional ESD, the potential for muscularis propria injury warrants further study in larger, multicenter trials.This simple and effective method holds promise for improving the efficiency and potentially the safety of colonic ESD.