Clin Endosc.  2013 Sep;46(5):467-471.

Debates on Colorectal Endoscopic Submucosal Dissection - Traction for Effective Dissection: Gravity Is Enough

• Lee BI

Abstract

Colorectal endoscopic submucosal dissection (ESD) still remains a technically difficult procedure. The maintenance of tissue tension and good submucosal exposure during dissection is one of the most important factors for an effective and safe dissection. Although various traction methods have been developed, traction by gravity is one of the most useful method for colorectal ESD. Traction using adjunctive devices can thus be reserved for extremely difficult cases or for endoscopists in their learning periods for colorectal ESD.

Keyword

Colorectal neoplasms; Endoscopic submucosal dissection; Traction; Gravitation

MeSH Terms

Colorectal Neoplasms
Gravitation
Learning
Traction

Figure

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  Fig. 1 Association between tissue tension and contact area. (A) Before applying tension. (B) After applying tension. Decreased contact area from increased tissue tension makes for an effective dissection.

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  Fig. 2 Improved submucosal exposure by traction. (A) Before traction. (B) After traction.

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  Fig. 3 Role of the distal transparent hood. (A) Insufficient submucosal exposure can be improved (B) by gently pushing the hood into the submucosal layer.

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  Fig. 4 The traction force by gravity during dissection. (A) Early stage of dissection. (B) After the dissection has progressed.

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