Role of Traction-Assisted Endoscopic Submucosal Dissection (ESD) in Large Esophageal Cancers
Annie Shergill* and Luis Nasiff
Larkin Community Hospital, Palm Springs Campus, Hialeah, FL, USA
*Corresponding author
Annie Shergill, Larkin Community Hospital, Palm Springs Campus, Hialeah, FL, USA.
Endoscopic Submucosal Dissection (ESD) facilitates en bloc resection of superficial gastrointestinal tumors but is a technically challenging procedure. An endoscopist cannot access the luminal tract like a surgeon to gain traction- which is the major challenge to overcome in ESD. This results in increased risk of perforation as well. Therefore, a traction device is used to aide the process of performing ESD without incurring any adverse events. Clip-with-line (CWL) is one such traction device, developed to perform taction-assisted ESD as compared to conventional ESD.
The CONNECT-E trial was a multicenter trial conducted in Japan that compared conventional ESD with traction-assisted ESD for treating large esophageal lesions [1]. Patients who were diagnosed endoscopically with esophageal cancers (squamous cell carcinoma or basal cell carcinoma with tumor diameter of > 20 mm) at stage T1a or T1b were randomly assigned to undergo conventional ESD or CWL-ESD. Results showed that the procedure time in the CWL-ESD group was significantly shorter than in the conventional ESD group for lesions occupying < 50% or > 50% but less than 100%. This was not significant for lesions covering the entire circumference.
The CONNECT-E trial also showed that there were no adverse events noted in the CWL-ESD group and technical difficulties such as incidence of perforation, piecemeal resection and inadvertent incisions were significantly reduced. This study has established a strong foot hold for continued use of traction assisted ESD over conventional ESD for large esophageal lesions in the near future.
References
- Yoshida M, Takizawa K, Nonaka S, Shichijo S, Suzuki S, et al. Conventional versus traction-assisted endoscopic submucosal dissection for large esophageal cancers: a multicenter, randomized controlled trial. Gastrointestinal Endoscopy. 2020. 91: 55-65.
