Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.
Department of Systems Medicine, Gastroenterology and Endoscopy Unit, Tor Vergata University of Rome, Rome, Italy.
Gastrointest Endosc. 2024 Sep;100(3):517-523. doi: 10.1016/j.gie.2024.02.032. Epub 2024 Mar 7.
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 (ATRACT Device and Co, Lyon, France) 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.
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 ileocecal valve, in contact with the pectinate line, or measuring more than two-thirds of the circumference).
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 mm. The mean operating time was 55.2 minutes, resulting in a mean resection speed of 61.4 mm/min. En bloc and R0 resection rates were 100% and 98%, respectively. Resections were curative in 94% of cases. Four (8%) perforations occurred, all of which were closed endoscopically without the need for surgery. One (2%) case of delayed hemorrhage was noted. To date, this is the series with the highest resection speeds in the literature for colorectal ESD. For comparison, previous studies reported a speed of 23.5 mm/min using the "pocket" strategy and a speed of 39.1 mm/min using the double-clip traction technique. These results need to be confirmed in larger studies and in nonexpert centers.
This prospective evaluation confirms the efficacy and safety of the adaptive traction strategy with the ATRACT device for colorectal ESD with high resection speed.
牵引已成为结直肠内镜黏膜下剥离术（ESD）的参考策略。其主要局限性之一是随着剥离的进行，牵引力会减小。ATRACT 牵引装置（ATRACT Device and Co，里昂，法国）使用滑轮系统在手术过程中增加牵引力，使其更容易和更快。一项针对整个消化道的 54 例回顾性研究显示了该装置在疗效和安全性方面的有趣结果。我们旨在通过前瞻性研究结直肠病变的切除术来证实这些初步结果。
在这项前瞻性多中心研究中，来自 3 个不同中心的 5 名经验丰富的操作人员连续使用 ATRACT 装置为所有常规部位的 4 至 10cm 大小的常规结直肠 ESD 进行了 10 例手术（无复发性病变、阑尾、回盲瓣、与梳状线接触或直径超过三分之二的病变）。
2022 年 11 月至 2023 年 4 月，49 名患者共进行了 50 例 ESD。平均而言，病变的主要直径为 66.6mm，表面积为 3066mm。平均手术时间为 55.2 分钟，切除速度平均为 61.4mm/min。整块和 R0 切除率分别为 100%和 98%。94%的病例切除具有治愈性。有 4 例（8%）发生穿孔，均在内镜下闭合，无需手术。有 1 例（2%）延迟性出血。到目前为止，这是结直肠 ESD 文献中切除速度最高的系列。相比之下，以前的研究报告使用“口袋”策略的速度为 23.5mm/min，使用双夹牵引技术的速度为 39.1mm/min。这些结果需要在更大的研究中和非专家中心中得到证实。
这项前瞻性评估证实了 ATRACT 装置的自适应牵引策略在结直肠 ESD 中的疗效和安全性，具有较高的切除速度。
