A novel clip-band traction device to facilitate colorectal endoscopic submucosal dissection and defect closure

摘要

Endoscopic submucosal dissection (ESD) allows for en bloc resection of large superficial lesions throughout the GI tract.1Ge P.S. Jirapinyo P. Ohya T.R. et al.Predicting outcomes in colorectal endoscopic submucosal dissection: a United States experience.Surg Endosc. 2019; 33: 4016-4025Crossref PubMed Scopus (12) Google Scholar,2Akintoye E. Kumar N. Aihara H. et al.Colorectal endoscopic submucosal dissection: a systematic review and meta-analysis.Endosc Int Open. 2016; 4: E1030-E1033Crossref PubMed Google Scholar Adequate visualization of the submucosal dissection plane is critically important for both safety and efficacy in ESD. In traditional surgery, an assistant provides effective countertraction. However, this is not feasible with endoscopic resection, wherein countertraction is naturally absent, aside from the effects of gravity acting on the partially resected lesion. Multiple devices and techniques have been proposed and investigated to enhance visualization of the submucosal space. Internal traction methods include the use of a nylon suture,3Chen P.J. Chu H.C. Chang W.K. et al.Endoscopic submucosal dissection with internal traction for early gastric cancer (with video).Gastrointest Endosc. 2008; 67: 128-132Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar the dental floss-clip traction (or clip-line) method,4Abe S. Oda I. Suzuki H. et al.A challenging case of gastric endoscopic submucosal dissection: removal of a sizable cancer through altering patient's position and multiple clip-line traction.VideoGIE. 2019; 4: 558-560Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar,5Yoshida M. Takizawa K. Suzuki S. et al.Conventional versus traction-assisted endoscopic submucosal dissection for gastric neoplasms: a multicenter, randomized controlled trial (with video).Gastrointest Endosc. 2018; 87: 1231-1240Abstract Full Text Full Text PDF PubMed Scopus (84) Google Scholar the classic clip-rubber band method,6Matsumoto K. Nagahara A. Ueyama H. et al.Development and clinical usability of a new traction device "medical ring" for endoscopic submucosal dissection of early gastric cancer.Surg Endosc. 2013; 27: 3444-3451Crossref PubMed Scopus (19) Google Scholar,7Parra-Blanco A. Nicolas D. Arnau M.R. et al.Gastric endoscopic submucosal dissection assisted by a new traction method: the clip-band technique. A feasibility study in a porcine model (with video).Gastrointest Endosc. 2011; 74: 1137-1141Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar a spring-action S-O clip,8Hashimoto R. Hirasawa D. Iwaki T. et al.Usefulness of the S-O clip for gastric endoscopic submucosal dissection (with video).Surg Endosc. 2018; 32: 908-914Crossref PubMed Scopus (27) Google Scholar and the suture pulley method.9Aihara H. Abidi W. Thompson C.C. Countertraction in endoscopic submucosal dissection.VideoGIE. 2016; 1: 36-37Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar,10Ge P.S. Thompson C.C. Jirapinyo P. et al.Suture pulley countertraction method reduces procedure time and technical demand of endoscopic submucosal dissection among novice endoscopists learning endoscopic submucosal dissection: a prospective randomized ex vivo study.Gastrointest Endosc. 2019; 89: 177-184Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar External traction devices include large double-balloon devices and robotic platforms. Recently, a novel clip-band traction device was introduced to the United States market (Elastic Traction Device; Micro-Tech Endoscopy USA Inc, Ann Arbor, Mich, USA), specifically indicated for providing retraction in endoscopic resection (Fig. 1). The device consists of 3 interconnected elastic silicone bands (one 1.5-mm ring and two 3.3-mm rings), preloaded onto a standard 11-mm hemostatic clip. The device has a working length of 235 cm, requires a working channel of ≥2.8 mm, and is compatible with standard gastroscopes and colonoscopes. There are 2 potential countertraction s