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 with adaptive traction strategy: first prospective multicenter study.

BACKGROUND AND AIMS: Traction has become the reference strategy for colorectal endoscopic submucosal dissection (ESD). One of its major limitations is that the force of traction decreases as dissection progresses. The ATRACT traction device uses a pulley system to increase traction during the procedure, making it easier and faster. A retrospective study of 54 cases showed interesting results in terms of efficacy and safety throughout the digestive tract. We sought to confirm these initial results with a prospective study of resections of colorectal lesions. METHODS: In this prospective multicenter study, 5 experienced operators from 3 different centers each performed 10 procedures using the ATRACT device consecutively for all conventional colorectal ESDs measuring between 4 and 10 cm in conventional locations (no recurrent lesions, appendicular, of the ileo-cecal valve, in contact with the pectinate line or measuring more than 2/3 of the circumference). RESULTS: Between November 2022 and April 2023, 50 ESDs were performed in 49 patients. On average, the main diameter of the lesions was 66.6 mm, with a surface area of 3066 mm2. The mean operating time was 55.2 minutes, resulting in a mean resection speed of 61.4 mm2/min. En Bloc and R0 resection rates were 100% and 98% respectively. Resections were curative in 94% of cases. 4 perforations (8%) occurred, all of which were closed endoscopically without the need for surgery. 1 case of delayed hemorrhage (2%) was noted. To date, this is the series with the highest resection speeds in the literature for colorectal ESD. For comparison, Yamamoto et al. reported a speed of 23.5 mm2/min using the "pocket" strategy and Bordillon et al. reported a speed of 39.1 mm2/min using the double-clip traction technique. These results need to be confirmed in larger studies, and in non-expert centers. CONCLUSIONS: This prospective evaluation confirms the efficacy and safety of the adaptive traction strategy with the ATRACT device for colorectal ESD with high resection speed.

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.

Generation of induced pluripotent stem cell line (TMOi001-A-11) carrying a homozygous deletion in the synemin gene using CRISPR/Cas9.

A number of genetic variants in the SYNM gene encoding for the intermediate filament synemin have been reported in patients with cardiomyopathies, skeletal myopathies, cancer and certain neurodegenerative disorders. To better understand its role, we generated a human induced pluripotent stem cell line with a homozygous deletion in the SYNM gene by CRISPR/Cas9 genome editing. The synemin-knockout human induced pluripotent stem cells exhibit typical morphology of pluripotent cells, expression of pluripotency markers, normal karyotype and differentiation capacity in the three germ layers. This line will allow us to investigate the role of synemin in cardiomyopathy upon differentiation into beating cardiomyocytes.

Endoscopic submucosal dissection of appendiceal lesions by using a novel adjustable traction device: A-TRACT-2.

Video 1Dissections of appendiceal lesions using A-TRACT-2.

Cyto- and bio-compatibility assessment of plasma-treated polyvinylidene fluoride scaffolds for cardiac tissue engineering.

As part of applications dealing with cardiovascular tissue engineering, drop-cast polyvinylidene fluoride (PVDF) scaffolds have been treated by cold plasma to enhance their adherence to cardiac cells. The scaffolds were treated in a dielectric barrier device where cold plasma was generated in a gaseous environment combining a carrier gas (helium or argon) with/without a reactive gas (molecular nitrogen). We show that an Ar-N2 plasma treatment of 10 min results in significant hydrophilization of the scaffolds, with contact angles as low as 52.4° instead of 132.2° for native PVDF scaffolds. Correlation between optical emission spectroscopy and X-ray photoelectron spectroscopy shows that OH radicals from the plasma phase can functionalize the surface scaffolds, resulting in improved wettability. For all plasma-treated PVDF scaffolds, the adhesion and maturation of primary cardiomyocytes is increased, showing a well-organized sarcomeric structure (α-actinin immunostaining). The efficacy of plasma treatment was also supported by real-time PCR analysis to demonstrate an increased expression of the genes related to adhesion and cardiomyocyte function. Finally, the biocompatibility of the PVDF scaffolds was studied in a cardiac environment, after implantation of acellular scaffolds on the surface of the heart of healthy mice. Seven and 28 days after implantation, no exuberant fibrosis and no multinucleated giant cells were visible in the grafted area, hence demonstrating the absence of foreign body reaction and the biocompatibility of these scaffolds.