Post written by Abel Joseph, MD, from the Department of Gastroenterology, Stanford University, Stanford, California, and Kornpong Vantanasiri, MD, from the Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.

Our study delves into endoscopic submucosal dissection (ESD) for treating T1b esophageal cancer (EC). Specifically, we compared 2 approaches: ESD with traction (Tr-ESD), which uses techniques or devices to better expose and dissect the submucosal layer, and conventional ESD without traction (cESD). Our primary aim was to evaluate the proportion of resections with negative vertical margins (VMs) between these methods.

EC remains a significant health challenge, ranking as the sixth-leading cause of cancer-related deaths in Western countries. Although endoscopic resection has emerged as a promising treatment for early-stage EC, positive VMs after ESD are a concern because of their association with increased recurrence risk.

Our motivation stemmed from observing patients with deep submucosal invasion who underwent Tr-ESD and still achieved negative VMs. This observation led us to hypothesize that traction during ESD might offer advantages in achieving negative VMs, potentially reducing recurrence rates. Given the implications for patient outcomes and the potential to refine ESD techniques, we believed it was crucial to investigate this further.

Our findings revealed that Tr-ESD was associated with a higher rate of negative VMs compared with cESD (69.8% vs 53.4%; P = .05). Furthermore, Tr-ESD was independently associated with negative VMs (odds ratio, 2.25; 95% confidence interval, 1.06-4.91; P = .037) and R0 resection (odds ratio, 2.83; 95% confidence interval, 1.33-6.23; P = .008), meaning complete resection without cancer at the margins. These results suggest that incorporating traction during ESD might offer a more effective approach for achieving negative VMs with T1b EC.

Tr-ESD for T1b EC could lead to better patient outcomes and reduced recurrence rates. The next step should involve well-designed prospective studies to validate our findings and explore optimal traction techniques and devices for ESD. Innovation in traction techniques holds exciting promise.

As technology continues to advance, we anticipate the development of new traction devices and techniques that could further optimize ESD procedures. These innovations could reduce procedural complexities, enhance precision, and minimize adverse events, ultimately leading to improved patient outcomes.

Graphical Abstract

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