Endoscopic submucosal dissection(ESD)has been developed as a treatment for superficial gastrointestinal neoplasms,which can achieve en bloc resection regardless of the lesion size.However,ESD is technically difficult ...Endoscopic submucosal dissection(ESD)has been developed as a treatment for superficial gastrointestinal neoplasms,which can achieve en bloc resection regardless of the lesion size.However,ESD is technically difficult because endoscopists cannot bring their hand into the gastrointestinal tract,unlike surgeons in regular surgery.It is difficult to obtain sufficient tension in the dissection plane and a good field of vision.Therefore,ESD is associated with a long procedure time and a high risk of adverse events in comparison with endoscopic mucosal resection.Traction methods have been developed to provide sufficient tension for the dissection plane and a good field of vision during the ESD procedure.However,traction direction is limited in most traction methods,resulting in insufficient effect in some cases.Although traction direction is considered important,there have been few investigations of its effect.In the first half of this review,important traction methods are discussed,including traction direction.In second half,appropriate traction methods for each organ are considered.Other important considerations for traction method,such as ability to adjust traction strength,interference between traction device and endoscope,and the need for specialized devices are also discussed.展开更多
Various traction devices have been developed to secure a visual field and sufficient tension at the dissection plane during endoscopic submucosal dissection(ESD).However,few large-scale studies have investigated the e...Various traction devices have been developed to secure a visual field and sufficient tension at the dissection plane during endoscopic submucosal dissection(ESD).However,few large-scale studies have investigated the effectiveness of traction devices in gastric ESD.Clip-with-line(CWL)is one such traction device that is widely used in cases of gastric ESD.The CONNECT-G trial was the first multicenter randomized controlled trial to compare conventional ESD with CWLassisted ESD(CWL-ESD)for superficial gastric neoplasms.Overall,no significant intergroup difference was observed in terms of the gastric ESD procedure time.However,subgroup analysis according to lesion location revealed a significant reduction in the procedure time of gastric ESD for the lesion located at the greater curvature of the middle and upper third of the stomach in the CWL-ESD group.In this subgroup analysis,lesion location was categorized as follows:anterior wall,posterior wall,lesser curvature,and greater curvature of the upper,middle,and lower thirds of the stomach.However,the gastric ESD procedure time showed no significant difference,except for lesions located at the greater curvature of the upper and middle thirds of the stomach.The traction direction of CWL in the stomach was limited to the cardia and changed depending on the lesion location.Therefore,outcomes of the CONNECT-G trail suggest that the effectiveness of CWL was influenced by lesion location,i.e.,traction direction.Further studies are warranted to investigate the optimal traction direction in gastric ESD.展开更多
文摘Endoscopic submucosal dissection(ESD)has been developed as a treatment for superficial gastrointestinal neoplasms,which can achieve en bloc resection regardless of the lesion size.However,ESD is technically difficult because endoscopists cannot bring their hand into the gastrointestinal tract,unlike surgeons in regular surgery.It is difficult to obtain sufficient tension in the dissection plane and a good field of vision.Therefore,ESD is associated with a long procedure time and a high risk of adverse events in comparison with endoscopic mucosal resection.Traction methods have been developed to provide sufficient tension for the dissection plane and a good field of vision during the ESD procedure.However,traction direction is limited in most traction methods,resulting in insufficient effect in some cases.Although traction direction is considered important,there have been few investigations of its effect.In the first half of this review,important traction methods are discussed,including traction direction.In second half,appropriate traction methods for each organ are considered.Other important considerations for traction method,such as ability to adjust traction strength,interference between traction device and endoscope,and the need for specialized devices are also discussed.
文摘Various traction devices have been developed to secure a visual field and sufficient tension at the dissection plane during endoscopic submucosal dissection(ESD).However,few large-scale studies have investigated the effectiveness of traction devices in gastric ESD.Clip-with-line(CWL)is one such traction device that is widely used in cases of gastric ESD.The CONNECT-G trial was the first multicenter randomized controlled trial to compare conventional ESD with CWLassisted ESD(CWL-ESD)for superficial gastric neoplasms.Overall,no significant intergroup difference was observed in terms of the gastric ESD procedure time.However,subgroup analysis according to lesion location revealed a significant reduction in the procedure time of gastric ESD for the lesion located at the greater curvature of the middle and upper third of the stomach in the CWL-ESD group.In this subgroup analysis,lesion location was categorized as follows:anterior wall,posterior wall,lesser curvature,and greater curvature of the upper,middle,and lower thirds of the stomach.However,the gastric ESD procedure time showed no significant difference,except for lesions located at the greater curvature of the upper and middle thirds of the stomach.The traction direction of CWL in the stomach was limited to the cardia and changed depending on the lesion location.Therefore,outcomes of the CONNECT-G trail suggest that the effectiveness of CWL was influenced by lesion location,i.e.,traction direction.Further studies are warranted to investigate the optimal traction direction in gastric ESD.
