Post written by Fatih Aslan, MD, from the Department of Gastroenterology and Advanced Endoscopy, Koc University Hospital, Istanbul, Turkey.

In this case, we describe a hand-suturing—assisted traction technique and closure applied during endoscopic submucosal dissection (ESD) for a 3-cm laterally spreading tumor in the cecum of a 47-year-old man. The technique used a barbed suture to facilitate traction during dissection and closure of the postresection defect.

Colorectal ESD is an advanced endoscopic procedure that enables en bloc resection of large lesions. However, it remains technically demanding. These challenges become even more pronounced when lesions are located in the proximal colon, between haustral folds, or at flexures. In addition, fibrotic lesions further complicate submucosal dissection. Such factors may lead to prolonged procedure times, lower en bloc resection rates, and increased risks of adverse events such as perforation and postpolypectomy syndrome.

We chose to share this video because it presents a simple, cost-effective, and widely accessible solution to these well-known challenges. By repurposing a barbed suture, a material commonly used in surgical practice, we were able to provide continuous and stable traction, significantly improving submucosal visibility and allowing for faster and safer dissection.

Endoscopists can take away several practical lessons:

• Effective traction is essential for successful ESD, particularly in difficult locations such as the proximal colon.
• Barbed sutures, available in most hospitals, can be easily adapted for continuous traction during dissection, acting as a “second hand” inside the lumen.
• This suture also can be immediately repurposed for postresection closure, simplifying workflow and avoiding the need for additional closure devices.
• This combined traction-closure approach reduces costs and procedural complexity while lowering the risk of delayed adverse events such as postpolypectomy syndrome.
• Most importantly, this technique is universally compatible with standard endoscopes, requires no proprietary equipment, and can be applied even in difficult areas such as the ileocecal valve and appendiceal orifice.

Ultimately, this case highlights how simple innovations, driven by creative use of existing surgical tools, can make advanced techniques such as ESD more accessible and achievable for a wider range of endoscopists. This technique is more than just a technical innovation—it reflects a broader mindset shift in advanced endoscopy. By integrating surgical thinking into endoscopic workflows, we can expand the therapeutic potential of endoscopy while keeping procedures cost-effective and efficient. In resource-limited centers where specialized accessories may not always be available, this approach offers a practical and realistic solution.

As therapeutic endoscopy evolves, cross-disciplinary innovations that blend surgical techniques with endoscopic practice will likely become even more important for improving technical success and patient safety. We encourage endoscopists everywhere to seek innovation not only through new devices, but also by rethinking how existing tools can be repurposed to solve complex procedural challenges.

Tightening the suture and passing it through the proximal colon fold to apply traction to the lesion.

Read the full article online.

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