Use of adaptive traction for endoscopic submucosal dissection when using a bipolar knife for cardiological reasons

Endoscopic submucosal dissection (ESD) allows en bloc resection of gastrointestinal lesions, providing completeness of resection and facilitating accurate histological assessment. The knives currently in use for ESD are monopolar devices that can cause electromagnetic interference with cardiac implantable electronic devices (CIEDs). Speedboat (Speedboat-RS2; Creo Medical Ltd, Chepstow, UK) is a novel bipolar device designed for ESD, which utilizes advanced energy (radiofrequency and microwave) for dissection and coagulation. It is an all-in-one device, capable of executing submucosal injection, dissection, and coagulation, making the procedure faster without interfering with CIEDs [1]. We report the use of this device during ESD with an adaptive traction instrument (A-TRACT 2+2; Hospices civils de Lyon, Lyon, France), the benefits of which have been described previously ([Video 1]) [2] [3] [4] [5].

Use of the adaptive traction device combined with a bipolar knife for endoscopic submucosal dissection of a gastric lesion.Video 1

A 75-year-old patient was referred to our center with a gastric flat lesion, 30×35 mm in size (high grade dysplasia at previous biopsies). ESD was indicated and a bipolar knife was preferred because of the patient’s pacemaker. After circumferential incision and trimming, we placed the A-TRACT 2+2 by fixing the two loops on lateral edges of the lesion and the rubber band to the opposite wall ([Fig. 1]). The dissection was started with appropriate traction and good submucosal exposure. After cutting half of the lesion, the adaptive traction was tightened to re-establish proper traction. The Speedboat device allowed safe dissection, and effective and immediate treatment of intraprocedural bleeding, without requiring any cardiological precaution due to the presence of the pacemaker. In addition, the traction device facilitated the procedure by ensuring optimal submucosal exposure until the end of the procedure. The procedure was completed in 40 minutes without events adverse, and the histopathology revealed curative resection of high grade dysplasia.

Fig. 1 Schematic representation of the adaptive traction device (A-TRACT 2+2; Hospices civils de Lyon, Lyon, France).

We suggest that the adaptative traction strategy could facilitate ESD, even when this new bipolar knife is selected in order to avoid complications in patients with CIEDs.

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Conflict of Interest

J. Jacques, M. Pioche, J. Rivory, and L.-J. Masgnaux are co-founders of the ATRACT devices and co. E. De Cristofaro and J. Grimaldi declare that they have no conflict of interest.

• References

• 1 Zaheer N, Reddy N. New kid on the block: “Speedboat”. J Digest Endosc 2022; 13: 89-95
• 2 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
• 3 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
• 4 De Cristofaro E, Masgnaux LJ, Saurin JC. et al. Multipolar adaptive traction makes endoscopic submucosal dissection feasible for large neoplastic area of the fundus in patient with familial adenomatous polyposis. Endoscopy 2023; 55 (Suppl. 01) E963-E964
• 5 De Cristofaro E, Rivory J, Masgnaux LJ. et al. Multipolar traction with an eight-point adaptive traction device allowed comfortable resection of a challenging giant rectal lesion in ulcerative colitis. Endoscopy 2023; 55 (Suppl. 01) E1029-E1030

Publication History

Article published online:
22 February 2024