title: Usefulness of a traction method using dental floss and a hemoclip for gastric endoscopic submucosal dissection: a propensity score matching analysis (with videos).
abstract: OBJECTIVE
  Although endoscopic submucosal dissection (ESD) is a significant advancement in therapeutic endoscopy, it is a complicated technique and requires considerable expertise. In this exploratory study, we evaluated the efficacy of a simple traction method that uses dental floss and a hemoclip (DFC) and was developed to overcome the technical difficulties of ESD.
  
  
  METHODS
  In total, 238 early gastric cancers treated by ESD between May 2012 and December 2014 at Tokyo Medical University were retrospectively reviewed. Lesions treated by conventional ESD (n = 185) and by ESD with DFC (ESD-DFC) (n = 53) were compared. Multivariable analyses and propensity score matching were used to compensate for the differences in age, sex, resected specimen size, lesion location, lesion position, presence of ulceration, and operator level. The procedure time, rate of en bloc and complete resection, and rates of adverse events were evaluated between the 2 groups.
  
  
  RESULTS
  Propensity score matching analysis created 43 matched pairs. Adjusted comparisons between ESD-DFC and conventional ESD showed similar treatment outcomes (en bloc resection rate: 97.7% vs 100%, P = .315; complete resection rate: 90.7% vs 95.3%, P = .397; perforation during ESD rate: 2.3% vs 2.3%, P = 1.000; post-ESD bleeding rate: 4.7% vs 4.7%, P = 1.000) but a significantly shorter procedure time for ESD-DFC (82.2 ± 79.5 minutes vs 118.2 ± 71.6 minutes, P = .002).
  
  
  CONCLUSIONS
  ESD-DFC facilitated rapid ESD with good visualization and traction while ensuring high curability and safety.
authors: Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
authors: Sho
authors: S
authors: Suzuki
authors: Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
authors: Takuji
authors: T
authors: Gotoda
authors: Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
authors: Yoshiyuki
authors: Y
authors: Kobayashi
authors: Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
authors: Shin
authors: S
authors: Kono
authors: Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
authors: Kunio
authors: K
authors: Iwatsuka
authors: Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
authors: Naoko
authors: N
authors: Yagi-Kuwata
authors: Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
authors: Chika
authors: C
authors: Kusano
authors: Endoscopy Center, Tokyo Medical University Hospital, Tokyo, Japan.
authors: Masakatsu
authors: M
authors: Fukuzawa
authors: Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
authors: Fuminori
authors: F
authors: Moriyasu
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D003742:Dental Devices, Home Care; D004210:Dissection / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D057216:Propensity Score; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000601:surgery*; D013525:Surgical Instruments; D014143:Traction; D016896:Treatment Outcome