Usefulness of the anchor traction method for multi-point traction in colorectal endoscopic submucosal dissection: a...

Various traction devices have been reported for colorectal endoscopic submucosal dissection (ESD), conventionally applying single-point traction during submucosal dissection. However, multi-point traction may improve submucosal layer visibility by enabling traction at a plane rather than a point. We developed a novel technique, the "anchor traction method," which enables three-point traction using a single multi-loop traction device (MLTD). This study aimed to evaluate the clinical utility of this method compared with that of the conventional approach in colorectal ESD.

We retrospectively reviewed 90 colorectal ESD cases performed using MLTDs. The primary outcome was resection speed. Secondary outcomes included operative time, en bloc resection rate, R0 resection, MLTD attachment time, MLTD dislodgement rate, and procedure-related complications.

Of the 90 patients, 47 were treated using the anchor traction method and 43 using the conventional method. The anchor traction group had a longer MLTD attachment time (median 191 s [range 52.0-313.0]) than the conventional traction group (78 s [20.0-193.0]) (p < 0.01), but achieved a faster resection speed (18.3 mm²/min [7.5-48.6] vs. 14.7 mm²/min [1.5-35.3], p = 0.02) and shorter operation time (41 min [16-100] vs. 47 min [13-217], p = 0.03). No significant differences were observed in en bloc resection rate, R0 resection, MLTD dislodgement rate, or in complications observed.

The anchor traction method demonstrated superior efficiency in terms of operation time and resection speed compared to conventional one-point traction in colorectal ESD.