TRACTION DEVICE-ASSISTED ENDOSCOPIC SUBMUCOSAL DISSECTION USING A NOVEL MULTI-LOOP TRACTION DEVICE

Abstract

Traction device-assisted ESD (TA-ESD) was developed to facilitate laborious ESD. Various traction devices have been developed to facilitate TA-ESD as the acceptability of the procedure has been increasing However, each device presents its own set of specific technical challenges. Therefore, their indications and techniques vary substantially. In February 2021, a novel multi-loop traction device (MLTD, Boston Scientific Japan, Tokyo) was released in the Japanese market. The device was developed by an academia-industry consortium established in 2014 at the department of endoscopy, the Jikei University School of Medicine to provide solutions for existing challenges in the field of gastrointestinal endoscopy. The device is designed as a triple-ring chain of light-weight resin measuring 19 mm in length. Because of its ideal size and lightness, the device can be delivered to a surgical field through an accessary channel using a regular endoscope and any type of endoclip. An endoscopist can create optimal strength of traction force on tissues toward any direction by attaching one end of the traction device on the edge of the surgically freed mucosal overlay and the other edge on the opposite site of the GI wall. In addition, the direction and force of traction can be changed intuitively by fixing the free second ring of the device on other locations on the GI wall. Finally, the light-weight device can be easily retrieved using biopsy forceps when the excised specimen is removed at the end of a procedure. In this article, we have reviewed previously published literature to discuss the advantages of the traction device-assisted technique. In addition, we have discussed the technological and procedural details of ESD using an MLTD.