A novel traction device applying the “anchor traction method” during pharyngeal endoscopic submucosal dissection

Endoscopic submucosal dissection (ESD) for pharyngeal cancer can be an effective method of preserving organ function. In this procedure, laryngeal forceps are used to directly grasp and pull the lesion; however, there are limitations in endoscopic manipulation owing to interference between the laryngeal forceps and the endoscope. Therefore, several methods that reduce interference have been reported [1] [2]. We previously reported a new method using a multi-loop traction device (MLTD; Boston Scientific Co. Ltd., Tokyo, Japan), named the “anchor traction method” to enable multiple traction points in colorectal ESD [3] [4]. Here, we report a useful technique in which this method was applied during ESD for pharyngeal cancer ([Video 1]).

A novel traction device applying the anchor traction method during pharyngeal endoscopic submucosal dissection.Video 1

The lesion was a 15-mm 0–IIa lesion at the left pyriform sinus ([Fig. 1]). After the otolaryngologist performed laryngeal expansion to create the space, marking and full-circumferential incision were done. The middle loop of the MLTD was attached to a reopenable clip (SureClip; MicroTech, Nanjing, China), and placed on the oral side of the lesion, and the two additional loops of the MLTD were then attached to the lesion, as previously reported in the anchor traction method ([Fig. 2]). The otolaryngologist grasped the middle loop using laryngeal forceps, and effective traction could be applied ([Fig. 3]). Successful traction was maintained with multiple points and en bloc resection was completed. Pathological analysis revealed that the lesion was squamous cell carcinoma pTis.

Fig. 1 The lesion was a 15-mm 0–IIa lesion at the left pyriform sinus.

Fig. 2 The multi-loop traction device was attached to the lesion as previously reported for the anchor traction method.

Fig. 3 A good field of view was obtained with multi-point traction using the multi-loop traction device.

The advantages of this method are as follows. First, as with other methods [1] [2], the use of the MLTD reduces interference between the endoscope and forceps, and also decreases lesion damage by reducing the number of times the forceps must re-grasp the lesion. Furthermore, as the MLTD can be tractioned at three points, the field of view is better than with traction at a single point. This method is therefore potentially useful for ESD in pharyngeal cancer.

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Conflict of Interest

The authors declare that they have no conflict of interest.

• References

• 1 Iwagami H, Shimoyama M, Terashita T. et al. Effective traction using a clip with rubber band and grasping forceps in endoscopic laryngopharyngeal surgery. Endoscopy 2023; 55: E566-E567
• 2 Matsuno K, Miyamoto H, Shono T. et al. Efficacy of a new traction method using ring shaped thread for endoscopic submucosal dissection in the pharynx. Esophagus 2023; 20: 256-263
• 3 Yamada K, Tajika M, Tanaka T. et al. A novel traction method using a multi-loop traction device in colorectal endoscopic submucosal dissection: anchor traction method. Endoscopy 2024; 56: E780-E781
• 4 Yamada K, Tajika M, Tanaka T. et al. Modified anchor traction method allows safe colorectal endoscopic submucosal dissection: the T-shaped traction method. Endoscopy 2025; 57: E64-E65

Publikationsverlauf

Artikel online veröffentlicht:
14. Juli 2025