title: Usefulness of the thread-traction method in esophageal endoscopic submucosal dissection: randomized controlled trial.
abstract: OBJECTIVE
  To assess the usefulness of the thread-traction method (TT method) in esophageal endoscopic submucosal dissection (ESD).
  
  
  METHODS
  A total of 40 lesions that were scheduled to be treated by esophageal ESD were included in the study. The TT method was used for 20 lesions (group TT) and conventional ESD was used for 20 lesions (group C) after randomization. The hook-knife method was used in all cases. In group TT, after circumferential mucosal incision, a clip with thread was attached to the oral edge of the lesion.
  
  
  RESULTS
  ESD was carried out in all cases. Effective countertraction was created by the TT method, and it was possible to carry out an efficient dissection operation. Significant shortening of dissection time was achieved in group TT compared with group C (19.8 min vs 31.8 min, P = 0.044). Mean number of local injections during dissection was significantly less in group TT compared with that in group C (0.6 times vs 2.2 times, P < 0.001). As for the amount of local injection, group TT required significantly less compared with group C (2.6 mL vs 7.5 mL, P < 0.01). No complications were encountered.
  
  
  CONCLUSIONS
  The TT method in esophageal ESD was safe and contributed to shortening of dissection time. The TT method is expected to become widespread as a safe and useful procedure.
authors.affiliation: Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Koike
authors.forename: Dai
authors.initials: D
authors.lastname: Hirasawa
authors.forename: Naotaka
authors.initials: N
authors.lastname: Fujita
authors.forename: Yuki
authors.initials: Y
authors.lastname: Maeda
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Ohira
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Harada
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Suzuki
authors.forename: Taku
authors.initials: T
authors.lastname: Yamagata
authors.forename: Megumi
authors.initials: M
authors.lastname: Tanaka
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004210:Dissection / Q000295:instrumentation* / Q000379:methods; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D009092:Mucous Membrane / Q000473:pathology / Q000601:surgery*; D061646:Operative Time; D010149:Postoperative Pain / Q000503:physiopathology / Q000628:therapy; D061214:Patient Safety; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D018570:Risk Assessment; D013525:Surgical Instruments; D015996:Survival Rate; D016896:Treatment Outcome
keywords: clip with thread; countertraction; endoscopic submucosal dissection (ESD); hook knife; squamous cell carcinoma