Traction-assisted ESD speeds up resection of colorectal tumour

Use of a traction device for endoscopic submucosal dissection (ESD) using a scissor-type knife in the proximal colon and for large lesions helps expedite resection in patients with superficial colorectal tumour, a study has shown.

A team of investigators conducted a multicentre randomized controlled trial at three Japanese institutions. They enrolled and randomly assigned patients with a 20‒50-mm superficial colorectal tumour to either a conventional ESD (n=49) or a traction-assisted ESD (n=48). Resection speed was the primary outcome.

The mean resection speed did not significantly differ in the entire cohort between the conventional and traction-assisted ESD groups (23.7 vs 25.6 mm²/min, respectively; p=0.43), but it was significantly faster with the traction-assisted ESD at the cecum (32.4 vs 16.7 mm²/min; p=0.02).

The mean resection speed of tumours ≥30 mm was also faster with traction-assisted than with conventional ESD (34.6 vs 27.8 mm²/min; p=0.054), and the mean procedure time was shorter for traction-assisted than for conventional ESD (47.3 vs 62.3 min; p=0.03).

On the other hand, the en bloc (100 percent vs 100 percent), complete (98.0 percent vs 97.9 percent), and curative resection (93.9 percent vs 91.7 percent) rates were comparable between the two groups.

In terms of adverse events, perforation and delayed haemorrhage occurred in the traction-assisted ESD group.

“Although the resection rates were sufficiently high and adverse event rates were extremely low in both the groups, the use of a traction device for ESD in the proximal colon and for large lesions may increase the resection speed,” the investigators said.