Endoscopic submucosal dissection assisted by adaptive traction: results of the first 54 procedures

Abstract

Background Good submucosal exposure is key to successful endoscopic submucosal dissection (ESD) and can be achieved with various traction devices. Nevertheless, these devices have a fixed traction force that tends to decrease as the dissection progresses. In contrast, the ATRACT adaptive traction device increases traction during the procedure.

Methods In this retrospective analysis of prospectively collected data (from a French database), we analyzed ESD procedures performed with the ATRACT device between April 2022 and October 2022. The device was used consecutively whenever possible. We collected details of lesion characteristics, procedural data, histologic outcomes, and clinical consequences for the patient.

Results 54 resections performed in 52 patients by two experienced operators (46 procedures) and six novices (eight procedures) were analyzed. The ATRACT devices used were the ATRACT-2 (n = 21), the ATRACT 2 + 2 (n = 30), and the ATRACT-4 (n = 3). Four adverse events were observed: one perforation (1.9 %), which was closed endoscopically, and three delayed bleeding events (5.5 %). The R0 rate was 93 %, resulting in curative resection in 91 % of cases.

Conclusion ESD using the ATRACT device is safe and effective in the colon and rectum, but can also be used to assist with procedures in the upper gastrointestinal tract. It may be particularly useful in difficult locations.

• References

• 1 Abe S, Wu SYS, Ego M. et al. Efficacy of current traction techniques for endoscopic submucosal dissection. Gut Liver 2020; 14: 673-684
• 2 Bordillon P, Pioche M, Wallenhorst T. et al. Double-clip traction for colonic endoscopic submucosal dissection: a multicenter study of 599 consecutive cases (with video). Gastrointest Endosc 2021; 94: 333-343
• 3 Grimaldi J, Lambin T, Rivory J. et al. Endoscopic submucosal dissection of an ileocecal valve laterally spreading tumor using an adaptable magnetic traction system. Endoscopy 2022; 54 (Suppl. 02) E1064-E1065
• 4 Omae M, Wang N, Löhr J-M. et al. Endoscopic submucosal dissection by using a new traction device. VideoGIE 2021; 6: 543-545
• 5 Masgnaux L-J, Grimaldi J, Legros R. et al. Endoscopic submucosal dissection in the colon using a novel adjustable traction device: A-TRACT-2. Endoscopy 2022; 54 (Suppl. 02) E988-E989
• 6 Masgnaux L-J, Jacques J, Pioche M. Endoscopic submucosal dissection of a duodenal lesion by using a novel adjustable traction device: A-TRACT-2. Dig Endosc 2023; 35: e3-e4
• 7 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
• 8 Yzet C, Masgnaux L-J, Rivory J. et al. Endoscopic submucosal dissection of colonic residual laterally spreading tumor with adaptive traction: use of the additional loops to improve traction focally in difficult area. Endoscopy 2023; 55 (Suppl. 01) E260-E261
• 9 Pioche M, Masgnaux L-J, Rivory J. et al. Endoscopic submucosal dissection in the colon with adaptive traction device: resection strategy and device setup. Endoscopy 2023; 55 (Suppl. 01) E171-E172
• 10 Masgnaux L-J, Grimaldi J, Rostain F. et al. Endoscopic submucosal dissection of appendiceal lesions by using a novel adjustable traction device: A-TRACT-2. VideoGIE 2022; 8: 81-83
• 11 Fabritius M, Gonzalez J-M, Becq A. et al. A simplified table using validated diagnostic criteria is effective to improve characterization of colorectal polyps: the CONECCT teaching program. Endosc Int Open 2019; 7: E1197-E1206
• 12 Patenotte A, Yzet C, Wallenhorst T. et al. Diagnostic endoscopic submucosal dissection for colorectal lesions with suspected deep invasion. Endoscopy 2023; 55: 192-197
• 13 Sato-Uemura R, Christiano-Sakai M, Duarte-Jordão R. et al. Endolifter, a new tool for safe and rapid submucosal endoscopic dissection. Rev Gastroenterol Mex 2014; 79: 161-165
• 14 Simsek C, Thompson CC, Alkhateeb KJ. et al. Novel articulating through-the-scope traction device. VideoGIE 2022; 7: 353-357
• 15 Chiu PW, Phee SJ, Bhandari P. et al. Enhancing proficiency in performing endoscopic submucosal dissection (ESD) by using a prototype robotic endoscope. Endosc Int Open 2015; 3: E439-E442