Impact of Traction Direction in Traction-Assisted Gastric Endoscopic Submucosal Dissection (with Videos)

Mitsuru Nagata; Masayuki Namiki; Tomoaki Fujikawa; Hiromi Munakata

doi:10.1007/s10620-023-07870-z

Impact of Traction Direction in Traction-Assisted Gastric Endoscopic Submucosal Dissection (with Videos)

Dig Dis Sci. 2023 Jun;68(6):2531-2544. doi: 10.1007/s10620-023-07870-z. Epub 2023 Feb 28.

Authors

Mitsuru Nagata¹, Masayuki Namiki², Tomoaki Fujikawa², Hiromi Munakata²

Affiliations

¹ Department of Endoscopy, Shonan Fujisawa Tokushukai Hospital, 1-5-1, Tsujidokandai, Fujisawa, Kanagawa, Japan. mitsuru10jp@yahoo.co.jp.
² Center for Digestive and Hepato-Biliary-Pancreatic Disease, Shonan Fujisawa Tokushukai Hospital, Fujisawa, Kanagawa, Japan.

Abstract

Background: The impact of traction direction in traction-assisted gastric endoscopic submucosal dissection (ESD) has not been adequately investigated. A clip with line (CWL) is a classical single-directional traction device. In contrast, a spring and loop with clip (SLC; S-O clip) is a newly developed multidirectional traction device.

Aims: To investigate the impact of traction direction in gastric ESD by comparing the procedure-related outcomes of CWL-assisted ESD (CWL-ESD) and SLC-assisted ESD (SLC-ESD).

Methods: We retrospectively examined 140 patients with superficial gastric neoplasms who underwent SLC-ESD or CWL-ESD by a single ESD expert during November 2017-September 2020. The traction direction was classified based on the endoscopic finding in the following five categories: proximal, diagonally proximal, vertical, diagonally distal, and distal. In SLC-ESD, we set vertical traction, using the multidirectional traction function. Propensity score matching was conducted to compensate for the differences in lesion size, injection function of electrosurgical knife, ulcerative lesion, lesion location, and lesion position. The primary outcome was gastric ESD procedure time.

Results: Propensity score matching created 42 pairs. The median gastric ESD procedure time in the SLC-ESD group was significantly shorter than that in the CWL-ESD group (28.3 min vs. 51.0 min, P = 0.022). All traction direction in the SLC-ESD group was vertical, while only 16.7% in the CWL-ESD group. En bloc resection was attained without perforation in all the patients in both groups.

Conclusion: Our findings suggest that SLC can provide vertical traction, which reduces the gastric ESD procedure time. Multidirectional traction devices can provide vertical traction in most cases of gastric ESD, unlike single-directional traction devices. Vertical traction may reduce the gastric ESD procedure time.

Keywords: Clip with line; Endoscopic submucosal dissection; Gastric ESD; Spring and loop with clip; S–O clip; Traction-assisted ESD.

MeSH terms

Endoscopic Mucosal Resection* / methods
Humans
Retrospective Studies
Stomach Neoplasms* / surgery
Traction
Treatment Outcome