Pulley Traction-Assisted Colonic Endoscopic Submucosal Dissection: A Retrospective Case Series

Background and Study Aims: We have reported the usefulness of traction-assisted colorectal endoscopic submucosal dissection (TAC-ESD) to overcome the technical difficulty of colorectal ESD. However, the direction of traction is toward the anal side only. We retrospectively evaluate the safety and efficacy of "pulley" TAC-ESD. Patients and Methods: We retrospectively analyzed patients diagnosed with colorectal polyps and treated by "pulley" TAC-ESD at Osaka International Cancer Institute from December 2017 to June 2018. Results: During the study period, 79 patients with 81 lesions were treated by ESD, and 54 of these patients were treated by traction-assisted ESD. Among them, 7 underwent "pulley" traction-assisted ESD (6 men, 1 woman; age, 48-69 years), resulting in en bloc resection with no complications. This afforded good visibility of the submucosal layer in 6 patients, but it was not effective in the remaining patient with the muscle-retracting sign. Conclusion: The "pulley" method affords good visibility of the submucosal layer by changing the traction direction in cases that are difficult to manage by conventional traction-assisted ESD.