ESD with adaptive traction strategy: result of the 54 first procedures

Aims Good submucosal exposure is a key factor for success during ESD, and can be achieved by different traction devices. Nevertheless, they all provide a fixed amount of traction force that tends to decrease as the dissection progresses. In contrast, the A-TRACT device, tightenable, offers the possibility of increasing traction during the procedure to improve exposure.

Methods In this retrospective study, we analyzed consecutive ESD procedures with the A-TRACT device between April 2022 and October 2022 from the French prospective database. The device was used consecutively whenever it was available. We collected lesion characteristics, procedure data as well as histological and clinical outcomes ([Table 1]).

Table 1  Procedure outcomes.

Results A total of 54 resections performed in 52 patients: Lesions were located in the stomach (3), duodenum (1), appendix (2), colon (43, including 5 invading the ileocecal valve), rectum (5). The mean maximum lesion diameter was (53±22mm), the mean lesion area was (2133±1961mm2), the mean procedure duration was (60±35min) with a dissection speed of (37.4±26,4 mm2/min). 3 adverse events were observed: 1 perforation (1.9%), closed endoscopically and 3 delayed bleeding (3.8%). One patient required secondary hemostatic endoscopy, and none required secondary operative surgery. The en bloc rate was 100%, with an R0 rate was 98%, resulting in curative resection in 90% of cases. In 5 cases, the A-TRACT device failed technically without preventing completion of the procedure [1] [2] [3] [4] [5] [6] [7].

Conclusions Endoscopic submucosal dissection using the A-TRACT device is safe and effective for the entire GI tract. It may be particularly useful in difficult locations, as well as for large lesions, and will likely improve resection speed.

Conflicts of interest

All authors except Thierry Ponchon are co-founders of the company A-TRACT device & co

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Publikationsverlauf

Artikel online veröffentlicht:
14. April 2023