title: Traction-assisted endoscopic mucosal resection for polypectomy in the large intestine.
abstract: OBJECTIVE
  To evaluate if traction-assisted endoscopic mucosal resection (TA-EMR) is feasible and if it enables en bloc resection of colorectal lesions.
  
  
  METHODS
  Seven patients with a total of 12 colorectal adenomas were prospectively enrolled. All lesions were removed by TA-EMR: one hemostatic clip tied to a white silk suture was applied to the base of the lesion to allow traction through the working channel of the colonoscope. A conventional polypectomy snare was mounted over the suture and the lesion was pulled into the snare and resected in one piece.
  
  
  RESULTS
  All 12 lesions (nine sessile) were resected en bloc with free lateral and vertical margins by using this novel technique, including five lesions (5/12, 41.6%) in less-accessible positions, where TA-EMR enabled complete visualization of the base before resection. Mean longest lesion and specimen sizes were 9 mm (range: 6-25 mm) and 11 mm in diameter (range: 7-17 mm), respectively. No serious procedure-related complications were observed.
  
  
  CONCLUSIONS
  TA-EMR through the endoscope using a hemostatic clip and suture material is technically feasible. Visualization of colorectal lesions in less-accessible locations can be improved.
authors.affiliation: Department of Surgery, St. John of God Hospital, Johannes von Gott Platz 1, A-1020 Vienna, Austria. bernhard.dauser@gmail.com
authors.forename: Bernhard
authors.initials: B
authors.lastname: Dauser
authors.forename: Thomas
authors.initials: T
authors.lastname: Winkler
authors.forename: Behrooz
authors.initials: B
authors.lastname: Salehi
authors.forename: Stefan
authors.initials: S
authors.lastname: Riss
authors.forename: Franz
authors.initials: F
authors.lastname: Beer
authors.forename: Friedrich
authors.initials: F
authors.lastname: Herbst
mesh_terms: D000236:Adenoma / Q000601:surgery*; D000368:Aged; D003111:Colonic Polyps / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D013525:Surgical Instruments; D013537:Sutures