Hand-made mesh traction band to improve lateral view in colorectal endoscopic submucosal dissection

In endoscopic submucosal dissection of large colorectal lesions, use of single traction results in a poor lateral view owing to the weight of the lesion. Conventional traction devices are not elastic, and use of additional traction clips induces excessive traction force and specimen damage, limiting the size of the lesions that can be accommodated [1] [2] [3]. Moreover, using multiple traction devices increases costs, complicates device removal procedures, and is time consuming [4] [5]. No single device that allows multiple lateral tractions in any situation has been established. Therefore, we developed a novel device: the mesh traction band (MTB).

The MTB device was produced by cutting commercially available polyethylene nets. Polyethylene is a safe material with excellent chemical resistance and insulating properties, and is used in food packaging. It was cut into rectangular sections of 15 × 20 mm (five rhombi each for length and width) and inserted through the endoscope channel with thin forceps grasping the short side of the device. Thereafter, the midpoints of the long sides were clipped to the resected specimen flap and the anal side of the opposite intestinal wall, respectively, for traction ([Fig. 1]). When necessary, lateral traction was added by clipping the rhombi at the left and right corners of the MTB to the specimen in the 4 and 8 o’ clock directions. The traction clips were pulled toward the center of the lumen, improving the view of the submucosa in all directions.

Fig. 1 Use of the mesh traction band (MTB) for traction during resection. a, b A polyethylene net was cut into rectangular sections of five rhombi across both length and width. c The MTB was inserted into the lumen through the endoscope channel with forceps, and clipped at the midpoints of the long sides to the specimen and intestinal wall for traction. d Lateral traction was available by clipping the rhombi at the corners of the MTB to the specimen.

The advantage of the MTB is that it is applicable regardless of the size or location of the lesion, as the elasticity of the mesh structure absorbs excessive traction force. [Video 1] shows a case in which the weight of the lesion interfered with the procedure. Additional lateral traction assisted in safe dissection.

Additional lateral traction with a mesh traction band in a case in which the weight of the lesion interfered with dissection.Video 1

The MTB is a novel device that facilitates additional lateral traction and reduces procedure difficulty in any situation ([Fig. 2]).

Fig. 2 Endoscopy and specimen images. a A large laterally spreading tumor in the cecum, over 100 mm in size and involving the ileocecal valve. b With a single point traction alone, it was difficult to reach the submucosal layer on the ileocecal valve side owing to the weight of the tumor. c Additional traction on the left side improved the submucosal view and allowed dissection while checking the stereo architecture of the muscular layer. d The tumor was completely resected without damage to the muscle layer and specimen.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Acknowledgement

We thank Editage for the English editing of the manuscript.

• References

• 1 Okubo Y, Kanesaka T, Takeuchi Y. Colonic tumor in a diverticulum removed by endoscopic submucosal dissection: two-step strategy using multi-loop traction devices. Dig Endosc 2022; 34: e119-e121
• 2 Inada T, Esaki M, Minoda Y. Triangle-traction-assisted endoscopic submucosal dissection with multiple loop traction device for colorectal neoplasms. Dig Endosc 2023; 35: e74-e75
• 3 Ge PS, Aihara H. A novel clip-band traction device to facilitate colorectal endoscopic submucosal dissection and defect closure. VideoGIE 2020; 5: 180-186
• 4 Ritsuno 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
• 5 Yamasaki Y, Takeuchi Y, Uedo N. et al. Efficacy of traction-assisted colorectal endoscopic submucosal dissection using a clip-and-thread technique: a prospective randomized study. Dig Endosc 2018; 30: 467-476

Publication History

Article published online:
14 October 2024