Traction-assisted endoscopic submucosal dissection to resect ileo-cecal valve neoplasia: a French retrospective multicenter case series.

INTRODUCTION: The ileocecal valve (ICV) is considered to be one of the most difficult locations for endoscopic submucosal dissection (ESD). The objective of this study was to evaluate the efficacy and safety of traction-assisted ESD in this situation. METHODS: All patients who underwent traction assisted ESD for an ICV lesion were identified from a prospective ESD database in three centers. The results were evaluated in terms of en bloc, R0 rate. Factors associated with R0 failure were explored. RESULTS: In total, 106 patients with an ileocecal lesion were included. The median diameter of the lesions was 50 mm (IQR 38-60) and 58.4% (62/106) invaded the terminal ileum. The en-bloc and R0 resection rates were 94.8% and 76.4%, respectively. Factors associated with R0 failure were lesions covering more than 75% of the ICV (OR, 0.21 [0.06, 0.76] p = 0.018), anal lip involvement (OR 0.36 [0.13, 0.99], p= 0.037), and more than two sites of the ICV (OR 0.28 [0.08, 1.01] p = 0.030). CONCLUSION: Traction-assisted ESD to treat ICV lesions is a safe and feasible option. Large lesions and anal lip involvement appear to be factors predictive of difficulty.

Endoscopic submucosal dissection assisted by adaptive traction: results of the first 54 procedures.

BACKGROUND : Good submucosal exposure is key to successful endoscopic submucosal dissection (ESD) and can be achieved with various traction devices. Nevertheless, these devices have a fixed traction force that tends to decrease as the dissection progresses. In contrast, the ATRACT adaptive traction device increases traction during the procedure. METHODS : In this retrospective analysis of prospectively collected data (from a French database), we analyzed ESD procedures performed with the ATRACT device between April 2022 and October 2022. The device was used consecutively whenever possible. We collected details of lesion characteristics, procedural data, histologic outcomes, and clinical consequences for the patient. RESULTS : 54 resections performed in 52 patients by two experienced operators (46 procedures) and six novices (eight procedures) were analyzed. The ATRACT devices used were the ATRACT-2 (n = 21), the ATRACT 2 + 2 (n = 30), and the ATRACT-4 (n = 3). Four adverse events were observed: one perforation (1.9 %), which was closed endoscopically, and three delayed bleeding events (5.5 %). The R0 rate was 93 %, resulting in curative resection in 91 % of cases. CONCLUSION: ESD using the ATRACT device is safe and effective in the colon and rectum, but can also be used to assist with procedures in the upper gastrointestinal tract. It may be particularly useful in difficult locations.