Ex vivo evaluation of a novel through-the-scope traction device for endoscopic submucosal dissection

Aims Endoscopic submucosal dissection (ESD) is a technique used for the resection of large neoplastic lesions in the gastrointestinal tract, providing great oncological outcomes. However, ESD is technically challenging with a long steep learning curve, high complication rates, and extended procedural times. To address these limitations, various traction-assisted methods have been developed in recent years. The study evaluates a novel through-the-scope traction device (TRACMOTION, Fujifilm, Japan) which offers consistent and adjustable traction, in a pilot multicenter randomized ex vivo trial.

Methods The study included six endoscopists with limited ESD experience performing ESD on ex vivo porcine stomach models at two centers. Participants were randomized into two groups: those using TRACMOTION-assisted ESD (TM-ESD) and those performing conventional ESD (C-ESD). Each trainee completed six procedures, split equally between both groups. Primary outcome was the resection speed, while secondary outcomes included en bloc, R0 resection rates, perforation rates, and rates of speedy procedures (> 20 mm²/min.)

Results TM-ESD group achieved a higher mean resection speed of 24.5 mm²/min (SD 13.96; 95%CI 17.56-31.44) in comparison to 15.2 mm²/min (SD 5.31; 95%CI 12.56-17.84) in the C-ESD group (p=0.01). A significantly higher rate of speedy procedures was reported in the TM-ESD group in comparison to the C-ESD group (50% (95% CI 0.260-0.739) vs. 16.7% ((95% CI 0.0358-0.4142) p=0.03). Perforation rates were significantly lower in the TM-ESD group (11.1% (95% CI 0.01-0.34) vs. 61.1% (95% CI 0.35-0.82; p=0.0002). No significant differences were observed in terms of en bloc and R0 resection rates between the groups [1] [2] [3].

Conclusions TRACMOTION significantly improves the efficiency of ESD, reducing procedural time and complication rates. Although further research in human trials is necessary to validate these findings, this traction device could potentially facilitate broader adoption of ESD in clinical practice.

 

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Conflicts of Interest

RM is a consultant for ERBE, Fujifilm, 3DMatrix and Boston Scientific. CH is a consultant for Fujifilm, Medtronic, and Olympus. AR is a consultant for Medtronic, ERBE, Fujifilm and Olympus. RG is consultant for Fujifilm, Medtronic, Boston Scientific and Provepharm

• References

• 1 Pimentel-Nunes P, Libânio D, Bastiaansen BAJ, Bhandari P, Bisschops R, Bourke MJ. et al. Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2022. Endoscopy. 2022; 54 (06): 591-622
• 2 Bordillon P, Pioche M, Wallenhorst T, Rivory J, Legros R, Albouys J. et al. Double-clip traction for colonic endoscopic submucosal dissection: a multicenter study of 599 consecutive cases (with video). Gastrointest Endosc 2021; 94 (02): 333-43
• 3 Grimaldi J, Masgnaux LJ, Lafeuille P, de Cristofaro E, Rivory J, Ponchon T. et al. Endoscopic submucosal dissection with adaptive traction strategy: first prospective multicenter study (with video). Gastrointest Endosc 2024; 100 (03): 517-23

Publication History

Article published online:
27 March 2025