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Unidirectional versus direction-selectable traction device in gastric endoscopic submucosal dissection: a randomized
Mitsuru Nagata1, Masayuki Namiki2, Tomoaki Fujikawa2
1Department of Endoscopy, Shonan Fujisawa Tokushukai Hospital, 1-5-1, Tsujidokandai, Fujisawa, Kanagawa, Japan. mitsuru10jp@yahoo.co.jp.
Surgical Endoscopy
|August 20, 2025
Summary
Direction-selectable traction devices, like the spring-and-loop with clip (SLC), significantly reduce procedure time for gastric endoscopic submucosal dissection (ESD) compared to unidirectional devices. This improved efficiency in treating superficial gastric neoplasms (SGNs) is linked to the use of vertical traction.
Area of Science:
- Gastroenterology
- Endoscopic Surgery
- Oncology
Background:
- Traction direction in gastric endoscopic submucosal dissection (ESD) remains understudied.
- Unidirectional (clip-with-line, CWL) and direction-selectable (spring-and-loop with clip, SLC) traction devices differ in their application.
- This study evaluates the impact of traction device type on outcomes for superficial gastric neoplasms (SGNs).
Purpose of the Study:
- To compare the procedural outcomes of CWL-assisted ESD and SLC-assisted ESD for SGNs.
- To investigate the influence of traction direction on ESD procedure time and efficiency.
- To determine if a direction-selectable device offers advantages over a unidirectional device in gastric ESD.
Main Methods:
- A single-center randomized controlled trial involving patients with SGNs.
- Random assignment to either CWL-assisted ESD or SLC-assisted ESD performed by an expert endoscopist.
- Analysis of primary endpoint (median ESD time) and secondary endpoints (dissection speed, complete resection rate, adverse events), with multiple regression for factor identification.
Main Results:
- SLC-assisted ESD demonstrated a significantly shorter median procedure time (26.0 min) compared to CWL-assisted ESD (40.5 min; P=0.015).
- Dissection speed was significantly faster with SLC-ESD (24.9 mm²/min) versus CWL-ESD (18.2 mm²/min; P=0.001).
- Vertical traction, utilized exclusively in SLC-ESD, was independently associated with reduced ESD time (P<0.001), while complete resection and adverse event rates were comparable.
Conclusions:
- Direction-selectable traction devices, exemplified by SLC, appear more effective than unidirectional devices for gastric ESD.
- The ability to select traction direction, particularly vertical traction, is a key factor in improving ESD efficiency.
- These findings suggest a potential benefit of direction-selectable devices for optimizing gastric ESD procedures.
