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DOI: 10.1055/a-2408-9787
A novel traction method using a multi-loop traction device in colorectal endoscopic submucosal dissection: Anchor traction method
Colorectal endoscopic submucosal dissection (ESD) continues to present technical challenges. However, several reports indicate that traction devices can reduce procedure time and complications associated with colorectal ESD [1] [2].
Conventional traction devices are limited in their ability to provide traction for large lesions as they can only do so at a single location. Here, we introduce a novel traction method utilizing the commercially available multi-loop traction device (Boston Scientific Co. Ltd., Tokyo, Japan).
A 61-year-old man presented with a 30-mm 0-Is+IIa lesion at the rectum, suspected to be an intramucosal carcinoma ([Fig. 1]). He underwent ESD ([Video 1]). Initially, a full circumferential incision was made using an ORISE ProKnife (Boston Scientific). Subsequently, the middle loop of the multi-loop traction device was attached to the reopenable clip (SureClip; MicroTech, Nanjing, China) using threads. The clip, along with the device, was initially attached to the anal side of the lesion. Then, the right loop was attached using a clip, this time on the right side of the lesion. The opposite loop was subsequently attached to the left side of the lesion. Finally, the middle loop was grasped and pulled into the intestinal mucosa on the opposite side of the lesion, allowing for traction in three locations using a single device ([Fig. 2]).
Quality:
After applying traction at multiple points, the submucosal layer became clearly visible, enabling the safe performance of ESD using a knife. Pathological analysis revealed that the lesion was a 30 × 25-mm adenocarcinoma in adenoma with negative margins ([Fig. 3]).
This novel traction method has been developed to enable traction at multiple locations using a single device, addressing the limitations of the conventional method, and we call it the anchor traction method because the traction shape resembles that of an anchor. The anchor traction method is a safe and effective method in colorectal ESD.
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Publication History
Article published online:
19 September 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
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References
- 1 Matsui H, Tamai N, Futakuchi T. et al. Multi-loop traction device facilitates gastric endoscopic submucosal dissection: ex vivo pilot study and an inaugural clinical experience. BMC Gastroenterol 2022; 22: 10
- 2 Rituno H, Sakamoto N, Osada T. et al. Prospective clinical trial of traction device-assisted endoscopic submucosal dissection of large superficial colorectal tumors using the S-O clip. Surg Endosc 2014; 28: 3143-3149