A novel endoscopic submucosal dissection technique with robust and adjustable tissue traction.
OBJECTIVE
A novel esophageal endoscopic submucosal dissection (ESD) technique was devised using a newly developed overtube to achieve adequate tissue traction. The aim of this study was to evaluate the feasibility and safety of this new full-traction ESD (tESD) technique.


METHODS
The key feature of tESD is tissue traction by grasping forceps, which is passed through the built-in side channel of the overtube. The strength and direction of traction is controlled by rotating the overtube and by adjusting its depth. The en bloc resection rate, procedure time, adverse events, and dissected area per minute were evaluated in a porcine model (n = 10) and compared with those of conventional ESD (n = 10).


RESULTS
tESD provided robust and adjustable tissue traction during the procedure. En bloc resection was accomplished in all lesions with no complications. Median procedure time was similar to that of the conventional technique (25 vs. 27 minutes; P = 0.4723) but the submucosal injection catheter was used less often (1.5 vs. 6; P < 0.01).


CONCLUSIONS
tESD might contribute to more efficient esophageal ESD by providing adequate tissue traction. This inexpensive technique may become an attractive option in esophageal ESD.
Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Masashi
M
Hirota
Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan.
Motohiko
M
Kato
Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Makoto
M
Yamasaki
Department of Gastroenterology, Osaka Police Hospital, Osaka, Japan.
Naoki
N
Kawai
Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Yasuhiro
Y
Miyazaki
Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan.
Takuya
T
Yamada
Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Tsuyoshi
T
Takahashi
Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan.
Tetsuo
T
Takehara
Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Masaki
M
Mori
Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Yuichiro
Y
Doki
Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Kiyokazu
K
Nakajima
D000818:Animals; D004210:Dissection / Q000009:adverse effects / Q000379:methods*; D004945:Esophagoscopy / Q000295:instrumentation*; D004947:Esophagus / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D009092:Mucous Membrane / Q000601:surgery*; D061646:Operative Time; D013552:Swine