Clinical Outcomes of Rubber-clip-assisted Versus Conventional Colorectal Endoscopic Submucosal Dissection: A...

Adequate traction is essential for safe and efficient colorectal endoscopic submucosal dissection (ESD), but gravitational traction is often insufficient in certain situations. Several traction techniques are reportedly effective. We use the rubber-clip method (RCM), which is a simple and inexpensive technique that combines a standard clip with a rubber band to allow directional traction adjustment. This study was performed to evaluate the clinical outcomes of RCM-assisted colorectal ESD.

Among 551 colorectal ESD procedures performed between January 2014 and October 2025, 452 patients were eligible for inclusion. Propensity score matching using seven covariates yielded 56 RCM and 56 non-RCM cases. The primary endpoint was procedure time, and the secondary endpoints were perforation, bleeding, en bloc resection, and pathological complete resection. Additionally, all procedures were classified as long-duration (≥120 min) or short-duration (<120 min) to identify independent risk factors for prolonged procedures, including intraoperative variables.

After matching, the RCM group showed a significantly shorter procedure time than the non-RCM group (66.8 vs. 90.7 min, respectively; p = 0.024) and a lower perforation rate (0.0 % vs. 10.7%, respectively; p = 0.027). In the multivariate analysis, absence of traction, non-expert endoscopist, moderate-to-severe fibrosis, large lesion size, and poor maneuverability were independent risk factors for prolonged procedures, with absence of traction showing the strongest association.

The RCM shortened procedure time and reduced perforation risk. Given its low cost, simplicity, and ability to adjust traction direction, the RCM may represent an effective traction method for colorectal ESD.

Trial Registration: N/A.