Efficacy and safety of different traction numbers in endoscopic submucosal dissection: a retrospective comparative...

Colorectal endoscopic submucosal dissection (ESD) presents persistent challenges such as limited visualization and prolonged procedure time. Single-point traction (ST) enhances dissection efficiency, but has limitations including diminished traction efficacy over time and the need for repositioning. We developed a novel multi-point traction (MT) device to provide stable and convergent traction. This study aimed to compare the efficacy and safety of non-traction (NT), ST, and MT for colorectal ESD.

This retrospective study analyzed colorectal ESD procedures performed at Nagasaki Harbor Medical Center between January 2019 and December 2024. The patients were categorized into three groups: NT, ST (S-O clip), and MT (novel multi-point traction device). The primary outcome was resection speed (mm²/min). Secondary outcomes included total resection time, local injection volume per unit area, en bloc resection rate, R0 resection rate, and the incidence of complications.

A total of 172 patients were eligible (NT 62, ST 67, MT 43), and after applying the exclusion criteria, 129 remained (NT 43, ST 51, MT 35) for the analyses of procedural parameters. The MT group achieved the highest resection speed (23.8 [IQR 18.9-33.2] mm²/min), exceeding ST by 5.2 mm²/min (95% CI 1.2-10.1) and NT by 5.8 mm²/min (95% CI 0.8-10.9). MT also demonstrated the lowest injection volume per resection area (p = 0.0057). Complications-perforation and postoperative bleeding-were comparable between groups.

Multi-point traction may improve resection efficiency, while maintaining safety during colorectal ESD. Future prospective multicenter trials are required to validate these findings and optimize the traction strategies.