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CC BY 4.0 · Endoscopy 2023; 55(S 01): E1029-E1030
DOI: 10.1055/a-2155-4772
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Multipolar traction with an eight-point adaptive traction device allowed comfortable resection of a challenging giant rectal lesion in ulcerative colitis

Elena De Cristofaro
1   Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
,
Jérôme Rivory
2   Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
,
Louis-Jean Masgnaux
2   Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
,
Jean Grimaldi
2   Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
,
Clara Yzet
3   Gastroenterology and Endoscopy Unit, Amiens University Hospital, Amiens, France
,
Sarah Leblanc
4   Gastroenterology and Endoscopy Unit, Mermoz Hospital, Lyon, France
,
Mathieu Pioche
2   Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
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Current guidelines recommend endoscopic resection for superficial colorectal neoplasia in patients with ulcerative colitis (UC), especially for clearly visible colitis-associated neoplasia [1]. However, endoscopic removal is technically challenging in UC, particularly for giant lesions. The major limitations to the widespread use of endoscopic submucosal dissection are the long procedure duration and the technical difficulty, particularly in the presence of fibrosis [2]. Several devices and techniques have been described to facilitate and speed up the procedure [1], and traction strategies have been increasingly implemented to improve the efficiency of dissection [3].

We previously described the benefits of using adaptive traction devices (A-TRACT 2 and A-TRACT 4) to anchor two or four points of the lesion [4] [5]. Here, we present the use and benefits of a specially designed adaptive traction device (A-TRACT 8) for multitraction via eight points in a giant rectal lesion in UC.

A 61-year-old man with UC had a large neoplastic area involving three-quarters of the circumference of the rectum. After circumferential incision and trimming, the first two loops were fixed by clips to the oral and anal edges of the target area. Six other loops were fixed on lateral edges of the lesion and another clip was attached to affix the rubber band to the opposite rectal wall ([Fig. 1], [Video 1]). The dissection was started with appropriate traction. When traction decreased after cutting half of the lesion, we tightened the A-TRACT 8 to re-establish proper traction. Good exposure of the submucosa was achieved thanks to the traction, which facilitated dissection at different depths and under fibrotic areas. The procedure duration was 200 minutes. Complete resection (R0) was achieved, without adverse events. Histopathology revealed low grade dysplasia.

Zoom Image
Fig. 1 Schematic representation after application of A-TRACT 8, which allowed excellent exposure of the submucosa.

Video 1 Challenging endoscopic submucosal dissection of a giant rectal lesion facilitated by A-TRACT 8. Image shows rectal dysplasia on ulcerative colitis.


Quality:

We hypothesize that such a dedicated device could facilitate resection of giant lesions, especially in selected cases, such as patients with inflammatory bowel disease, where the technical difficulties due to fibrosis can represent a great challenge and result in a time-consuming procedure.

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Publication History

Article published online:
15 September 2023

© 2023. 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 Bak MTJ, Albéniz E, East JM. et al. Endoscopic management of patients with high-risk colorectal colitis-associated neoplasia: a Delphi study. Gastrointest Endosc 2023; 97: 767-779.e6
    CrossrefPubMedSearch in Google Scholar
  • 2 Suzuki N, Toyonaga T, East JE. Endoscopic submucosal dissection of colitis-related dysplasia. Endoscopy 2017; 49: 1237-1242
    Thieme ConnectPubMedSearch in Google Scholar
  • 3 Lafeuille P, Rivory J, Jacques J. et al. Diagnostic endoscopic submucosal dissection for invasive cancer with the four cardinal points traction strategy. Endoscopy 2022; 54: E281-E282
    Thieme ConnectPubMedSearch in Google Scholar
  • 4 Masgnaux LJ, Pioche M, Rivory J. et al. Endoscopic submucosal resection with adaptative traction device: a new strategy to facilitate resection in patient with inflammatory bowel disease. Endoscopy 2023; 55 (Suppl. 01) E466-E467
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 Grimaldi J, Masgnaux L-J, Rivory J. et al. Multipolar traction with adjustable force increases procedure speed during endoscopic submucosal dissection: the A-TRACT-4 traction device. Endoscopy 2022; 54 (Suppl. 02) E1013-E1014
    Search in Google Scholar