Abstract
Background Colorectal endoscopic submucosal dissection (ESD) is a technically demanding but effective treatment for superficial neoplasms. We conducted a study to compare the effectiveness and safety of inner traction facilitated ESD using rubber band and clip (RAC-ESD) with conventional ESD.Methods We retrospectively evaluated 622 consecutive patients underwent colorectal ESD between January 2016 and December 2019. To overcome selection bias, we used propensity score matching (1:4) between RAC-ESD and conventional ESD. The frequency of en bloc resections, R0 resections, curative resections, procedure speed and complications were evaluated.Results After propensity score matching, 35 patients were included in RAC-ESD group and 140 were included in conventional ESD group. RAC-ESD resulted in a significant increase in resection speed (0.14 vs. 0.09 cm2/min; P=0.003). There were no significant differences in en bloc, R0 and curative resection rates between two groups. In subgroup analysis, the resection speed of RAC-ESD was significantly higher than conventional ESD when the lesions were equal to or larger than 2cm, macroscopically presenting as lateral spreading tumor, and located in transverse colon to ascending colon.Conclusions RAC-ESD is safe and effective in treating colorectal neoplasms, especially in lesions presenting particular difficulty.
Double-clip counter-traction using a rubber band is a useful and adaptive tool for colonic endoscopic submucosal dissection