University of California Irvine Medical Center Orange, CA, United States
Vamsi Vemireddy, MD1, Jennifer Kolb, MD, MS2, Peter H. Nguyen, MD2, Anastasia Chahine, MD3, Nathan Park, MD4, Rochelle Simoni, BSc5, Kenneth Chang, MD6, Jason Samarasena, MD7 1University of California Irvine Medical Center, Orange, CA; 2University of California Irvine, Orange, CA; 3H. H. Chao Comprehensive Digestive Disease Center, University of California Irvine, Orange, CA; 4UC Irvine Medical Center, Orange, CA; 5UC Irivne, Orange, CA; 6Digestive Health Institute, UC Irvine, Orange, CA; 7University of California - Irvine, Orange, CA
Introduction: Endoscopic submucosal dissection (ESD) is considered the gold standard in removing superficial gastrointestinal cancers. ESD is associated with significant complications including perforation and bleeding. Maintaining traction in these procedures is essential to improve safety and efficacy. Having a clear view of the submucosa and sufficient tension of the tissue significantly improves the quality of the resection while minimizing complications. In this study we describe the use of a novel curved traction wire, created with the intention of improving the safety of ESD by providing long lasting traction with clear visualization of the submucosal plane.
Case Description/Methods: Of the five total ESD procedures performed with this device, the lesions resected include two in the rectum, one in the colon, one in the esophagus, and one in the stomach. In each case, once present at that lesion, the primary grasping clip was guided through the endoscope and placed at mucosal flap at the near-end of the lesion. The secondary anchoring clip was then placed on normal mucosa next to the far end of the lesion. Once attached, the curved wire returned to its original shape and retracted the lesion to provide enhanced visualization of the submucosal plane for dissection. In all 5 cases, there was no evidence of active bleeding or perforation. In all cases, there were no issues with set up or deployment of the device.
Discussion: The use of this novel curved traction wire allowed for better visualization of submucosal plane when performing ESD procedures. One point we observed for improving technique with this device involved placement of the secondary anchoring clip. We felt it is important not to place that clip too far from the far-end of the lesion as the resultant tension may be too great and less optimal. This device has the potential to decrease total procedure time and increase safety of ESD procedures.
Figure: Figure 1 (a) Traction wire with both grasping clips in place (b) Increased exposure of submucosal plane with traction wire in place
Vamsi Vemireddy indicated no relevant financial relationships.
Jennifer Kolb indicated no relevant financial relationships.
Peter Nguyen indicated no relevant financial relationships.
Anastasia Chahine indicated no relevant financial relationships.
Nathan Park indicated no relevant financial relationships.
Rochelle Simoni indicated no relevant financial relationships.
Jason Samarasena: Medtronic – Consultant, Speaker's Bureau.
Vamsi Vemireddy, MD1, Jennifer Kolb, MD, MS2, Peter H. Nguyen, MD2, Anastasia Chahine, MD3, Nathan Park, MD4, Rochelle Simoni, BSc5, Kenneth Chang, MD6, Jason Samarasena, MD7. P2773 - The New Traction Attraction: ESD With a Novel Traction Wire, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.