Post written by Hiroyuki Aihara, MD, PhD, Director, Endoscopic Tissue Resection Program, Brigham and Women’s Hospital, and Associate Professor of Medicine, Harvard Medical School, Boston, Massachusetts, USA.

Current techniques and devices for traction in endoscopic submucosal dissection (ESD) own inherent limitations such as technical complexity, lack of adjustability, or demanding preparation.

Recently, a single-operator, through-the-scope, articulating traction device was developed to enable an effective traction strategy. In this video, we demonstrate 2 cases of ESD using this novel traction device.

The first case is about a patient who was found to have a flat adenoma in the gastric antrum. In the second case, a patient had a 5-cm laterally spreading tumor granular-type lesion.

In both cases, the traction device provided an excellent view of the submucosal dissection plane and allowed for a safe and effective resection. With the instant grasping and regrasping ability, the traction could be easily applied at the different sites of the lesion throughout the procedure. The single-operator capability also allowed an independent control of the device by the endoscopist.

ESD procedures with this device must be performed under a distant view because of the large working space required for the traction device. Based on this, a scissors-type or hook-shaped knife would be recommended for more stable tissue dissection.

This novel traction device can potentially improve complete resection rates and prevent adverse events in ESD. Despite the success in these cases, studies with endoscopists with different experience levels in ESD should be conducted.

Overview of the traction device. A, Device consists of 2 parts, hand controller and distal articulating arm and jaw, which are connected by a cable. B, Distal arm has an articulating and rotatable grasper. C, The device is inserted through the 3.7-mm instrument channel, and the hand controller is mounted on the biopsy port.

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