Efficacy of traction-assisted colorectal endoscopic submucosal dissection using a clip-and-thread technique: a prospective randomized study

Abstract

Objectives

Colorectal endoscopic submucosal dissection (ESD) remains challenging because of technical difficulties, long procedure time, and high risk of adverse events. To facilitate colorectal ESD, we developed traction-assisted colorectal ESD using a clip-and-thread (TAC-ESD) and conducted a randomized controlled trial to evaluate its efficacy.

Methods

Patients with superficial colorectal neoplasms (SCNs) ≥20 mm were enrolled and randomly assigned to the conventional-ESD or TAC-ESD group. SCNs ≤50 mm were treated by two intermediates, and SCNs >50 mm were treated by two experts. The primary endpoint was the procedure time. Secondary endpoints were the TAC-ESD success rate (sustained application of the clip-and-thread until the end of the procedure), self-completion rate by the intermediates, and adverse events.

Results

Altogether, 42 SCNs were analyzed in each ESD group (conventional and TAC). The procedure time (median [range]) for the TAC-ESD group was significantly shorter than that for the conventional-ESD group (40 [11–86] min vs. 70 [30–180] min, respectively; P<0.0001). The success rate of TAC-ESD was 95% (40/42). The intermediates' self-completion rate was significantly higher for the TAC-ESD group than for the conventional-ESD group (100% [39/39] vs. 90% [36/40], respectively; P=0.04). Adverse events included one intraoperative perforation in the conventional-ESD group and one delayed perforation in the TAC-ESD group.

Conclusions

TAC-ESD reduced the procedure time and increased the self-completion rate by the intermediates. (UMIN000018612)

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