Endoscopic intermuscular dissection of rectal T1 cancer with adaptive traction: use of the additional loops to improve traction directly on the circular muscular layer

Abstract Text Endoscopic R0 resection rate for T1 cancers harboring focal invasive patterns is far from perfect on the vertical margin. Recently, Endoscopic intermuscular dissection (EID) was described to get a free vertical margins by dissecting deeper, between the two muscular layers. This approach is feasible in the rectum where the two layers are thick combines the benefits of maintaining the rectal longitudinal muscle and dissecting deeper to get clear free vertical margins when deep submucosa is invaded. To facilitate intermuscular space exposure, as described in ESD, traction seems useful. We describe here an adaptive traction device, (A-TRACT, Hospices Civils de Lyon, France), that could be helpful in this situation [1] [2] [3] [4] [5].

Conflicts of interest

All authors are co-founder of the company A-TRACT device & co

• 1 Masgnaux LJ, Grimaldi J, Legros R, Rivory J, Wallenhorst T, Jacques J. et al. Endoscopic submucosal dissection in the colon using a novel adjustable traction device: A-TRACT-2. Endoscopy.. 2022
• 2 Grimaldi J, Masgnaux LJ, Rivory J, Legros R, Wallenhorst T, Jacques J. et al. Multipolar traction with adjustable force increases procedure speed during endoscopic submucosal dissection: the A-TRACT-4 traction device. Endoscopy.. 2022
• 3 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
• 4 Moons LMG, Bastiaansen BAJ, Richir MC, Hazen WL, Tuynman J, Elias SG. et al. Endoscopic intermuscular dissection for deep submucosal invasive cancer in the rectum: a new endoscopic approach. Endoscopy. 2022; 54 (10) 993-8
• 5 Patenotte A, Yzet C, Wallenhorst T, Subtil F, Leblanc S, Schaefer M. et al. Diagnostic endoscopic submucosal dissection for colorectal lesions with suspected deep invasion. Endoscopy.. 2022

Publication History

Article published online:
14 April 2023