Efficacy of a Traction Device for Endoscopic Submucosal Dissection Using a Scissor-Type Knife: A Randomized Controlled Trial

• Published in: The American journal of gastroenterology Vol. 117; no. 11; pp. 1797 - 1804
• Main Authors: Tamaru, Yuzuru, Kuwai, Toshio, Miyakawa, Akihiro, Kanazawa, Noriyoshi, Kusunoki, Ryusaku, Shimura, Haruhisa, Uchiyama, Shiori, Ishaq, Sauid, Kohno, Hiroshi
• Format: Journal Article
• Language: English
• Published: New York Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins 01.11.2022
• Subjects: Cancer; Clinical trials; Colorectal cancer; Dissection; Endoscopy; Gastroenterology; Knives; Tumors; Japan
• ISSN: 0002-9270; 1572-0241
• DOI: 10.14309/ajg.0000000000002019

INTRODUCTION: Although safe, colorectal endoscopic submucosal dissection (ESD) using a scissor-type knife has a slow resection speed. We aimed to evaluate the efficacy of a traction device to hasten the resection speed. METHODS: This multicenter randomized controlled trial was conducted at 3 Japanese institutions. Patients with a 20–50-mm superficial colorectal tumor were enrolled and randomly assigned to a conventional-ESD (C-ESD) group or a traction-assisted ESD (T-ESD) group. The primary outcome was the resection speed. RESULTS: The C-ESD and T-ESD groups comprised 49 and 48 patients, respectively. Although the mean resection speed was not significantly different in the entire cohort between the groups (23.7 vs 25.6 mm 2 /min, respectively; P = 0.43), it was significantly faster with T-ESD than with C-ESD at the cecum (32.4 vs 16.7 mm 2 /min, respectively; P = 0.02). The mean resection speed of tumors ≥30 mm tended to be faster by T-ESD than by C-ESD (34.6 vs 27.8 mm 2 /min, respectively; P = 0.054). The mean procedure time of T-ESD was significantly shorter than that of C-ESD (47.3 vs 62.3 minutes, respectively; P = 0.03). The en bloc (100% vs 100%), complete (98.0% vs 97.9%), and curative resection (93.9% vs 91.7%) rates were similar between the 2 groups. Perforation and delayed hemorrhage occurred in only 1 patient each in the T-ESD group. DISCUSSION: Although the resection rates were sufficiently high and adverse event rates were extremely low in both the groups, the use of a traction device for ESD in the proximal colon and for large lesions may increase the resection speed.