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Published on: February 13, 2026
Multitraction point strategy for endoscopic submucosal dissection in managing difficult colorectal lesions.
Abdulrahman Qatomah1,2, Daryl Ramai1, Aishah Qatomah3
1Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Summary
The multitraction point (MTP) technique offers a safe and effective solution for challenging colorectal endoscopic submucosal dissections (ESD), particularly for large lesions. This method facilitates en bloc resection with clear margins, proving valuable when conventional techniques are insufficient.
Area of Science:
- Gastroenterology
- Endoscopic Surgery
- Oncology
Background:
- Colorectal endoscopic submucosal dissection (ESD) is crucial for en bloc resection but technically demanding for large or difficult lesions.
- While traction methods improve outcomes, single-point traction may be insufficient for bulky tumors.
- The multitraction point (MTP) technique is explored for enhanced colorectal ESD.
Purpose of the Study:
- To report the outcomes of the multitraction point (MTP) technique in colorectal endoscopic submucosal dissection (ESD).
- To evaluate the safety and efficacy of MTP for large or unfavorably located colorectal lesions.
Main Methods:
- A case series video presentation of 3 patients undergoing MTP for large colorectal tumors.
- Strategic placement of multiple traction points to optimize submucosal plane visualization.
- En bloc resection with careful dissection to avoid deep mural injury.
Main Results:
- Successful en bloc resection was achieved in all 3 cases of large laterally spreading tumors.
- No adverse events were reported during or after the MTP procedures.
- Final pathology confirmed complete resection with R0 margins for tubulovillous adenomas.
Conclusions:
- The MTP technique is safe and effective for achieving curative resection in anatomically challenging colorectal ESD.
- MTP is a valuable alternative when other traction methods are not feasible.
- Further research is needed to assess MTP's generalizability and long-term outcomes.
