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Background <p>The effects of traction direction in traction-assisted gastric endoscopic submucosal dissection (ESD) are underexplored. The clip-with-line (CWL) and spring-and-loop with clip (SLC) are unidirectional and direction-selectable traction devices, respectively. This study compared the procedure-related outcomes of CWL-assisted ESD (CWL-ESD) and SLC-assisted ESD (SLC-ESD) for superficial gastric neoplasms (SGNs).</p> Methods <p>This single-center randomized controlled trial included patients with SGNs who were randomly assigned to undergo CWL-ESD or SLC-ESD performed by an expert. The traction direction was classified as proximal, diagonally proximal, vertical, diagonally distal, or distal. Vertical traction (VT) was selected for SLC-ESD using the direction-selectable traction function. The primary endpoint was the median ESD time. The secondary endpoints included dissection speed. Multiple regression analysis was used to identify factors affecting ESD time.</p> Results <p>Overall, 105 patients who underwent SLC-ESD (<i>n</i> = 52) or CWL-ESD (<i>n</i> = 53) between August 2020 and April 2023 were included in the analysis. The median ESD time was significantly shorter in the SLC-ESD group than in the CWL-ESD group (26.0 vs. 40.5 min; <i>P</i> = 0.015). The median dissection speed was significantly faster in the SLC-ESD group than in the CWL-ESD group (24.9 vs. 18.2 mm<sup>2</sup>/min; <i>P</i> = 0.001). The traction direction significantly differed between the groups (<i>P</i> &lt; 0.001), as VT was selected in all cases in the SLC-ESD group, compared with that in 11.3% of cases in the CWL-ESD group. Multiple regression analysis revealed that VT was independently associated with a shorter ESD time (<i>P</i> &lt; 0.001). The complete resection rate did not differ between the groups (98.1% vs. 96.2%; <i>P</i> = 1.000). Adverse event rates were not different between the groups.</p> Conclusions <p>A direction-selectable traction device may be more effective than a unidirectional traction device in gastric ESD.</p> Graphical abstract <p></p>

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Unidirectional versus direction-selectable traction device in gastric endoscopic submucosal dissection: a randomized controlled trial

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年8月20日

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  • Mitsuru Nagata,
  • Masayuki Namiki,
  • Tomoaki Fujikawa,
  • Hiromi Munakata

摘要

Background

The effects of traction direction in traction-assisted gastric endoscopic submucosal dissection (ESD) are underexplored. The clip-with-line (CWL) and spring-and-loop with clip (SLC) are unidirectional and direction-selectable traction devices, respectively. This study compared the procedure-related outcomes of CWL-assisted ESD (CWL-ESD) and SLC-assisted ESD (SLC-ESD) for superficial gastric neoplasms (SGNs).

Methods

This single-center randomized controlled trial included patients with SGNs who were randomly assigned to undergo CWL-ESD or SLC-ESD performed by an expert. The traction direction was classified as proximal, diagonally proximal, vertical, diagonally distal, or distal. Vertical traction (VT) was selected for SLC-ESD using the direction-selectable traction function. The primary endpoint was the median ESD time. The secondary endpoints included dissection speed. Multiple regression analysis was used to identify factors affecting ESD time.

Results

Overall, 105 patients who underwent SLC-ESD (n = 52) or CWL-ESD (n = 53) between August 2020 and April 2023 were included in the analysis. The median ESD time was significantly shorter in the SLC-ESD group than in the CWL-ESD group (26.0 vs. 40.5 min; P = 0.015). The median dissection speed was significantly faster in the SLC-ESD group than in the CWL-ESD group (24.9 vs. 18.2 mm2/min; P = 0.001). The traction direction significantly differed between the groups (P < 0.001), as VT was selected in all cases in the SLC-ESD group, compared with that in 11.3% of cases in the CWL-ESD group. Multiple regression analysis revealed that VT was independently associated with a shorter ESD time (P < 0.001). The complete resection rate did not differ between the groups (98.1% vs. 96.2%; P = 1.000). Adverse event rates were not different between the groups.

Conclusions

A direction-selectable traction device may be more effective than a unidirectional traction device in gastric ESD.

Graphical abstract