Post written by Hiroyuki Aihara, MD, PhD, from the Developmental Endoscopy Lab, Harvard Medical School, and Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, Massachusetts, USA.

The lack of reliable countertraction in endoscopic submucosal dissection (ESD) contributes to its technical demand and increased procedure time. In our previous ex vivo study, we demonstrated that the suture pulley countertraction method in ESD enhances direct visualization of the submucosal layer and facilitates ESD when performed by an expert in ESD. In this study, we aimed to prospectively evaluate the efficacy of this method in endoscopists considered novices for both endoscopic suturing and ESD.

The subjects were randomized to either traditional or suture pulley ESD first and performed ESD using each technique. Mean total procedure time was shorter using suture pulley ESD compared with traditional ESD (26.7 ± 7.3 vs 59.4 ± 20.4 minutes, P < .001). Submucosal dissection time was shorter using suture pulley ESD compared with traditional ESD (8.4 ± 2.9 vs 47.2 ± 16.3 minutes, P < .001). Physical and mental workloads on the participants determined by the NASA Task Load Index were significantly improved using the suture pulley ESD method (P < .001). The results of this study have potential implications for ESD training in the United States.

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