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 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. 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 ileo-cecal valve, in contact with the pectinate line or measuring more than 2/3 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 mm2. The mean operating time was 55.2 minutes, resulting in a mean resection speed of 61.4 mm2/min. En Bloc and R0 resection rates were 100% and 98% respectively. Resections were curative in 94% of cases. 4 perforations (8%) occurred, all of which were closed endoscopically without the need for surgery. 1 case of delayed hemorrhage (2%) was noted. This prospective evaluation confirms the efficacy and safety of the adaptive traction strategy with the ATRACT device for colorectal ESD with high resection speed.

中文翻译：

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采用自适应牵引策略的内镜粘膜下剥离术：首个前瞻性多中心研究

牵引已成为结直肠内镜粘膜下剥离术（ESD）的参考策略。其主要局限性之一是牵引力随着解剖的进展而减小。ATRACT 牵引装置使用滑轮系统来增加手术过程中的牵引力，使其更容易、更快。对 54 例病例的回顾性研究显示了在整个消化道的有效性和安全性方面的有趣结果。在这项前瞻性多中心研究中，来自 3 个不同中心的 5 名经验丰富的操作员分别使用 ATRACT 设备连续进行了 10 次手术，对所有常规结直肠 ESD 测量，在常规位置测量 4 至 10 厘米（无复发性病变、阑尾、回盲肠瓣、与梳状线接触或测量超过圆周的 2/3）。2022年11月至2023年4月期间，对49名患者进行了50次ESD。平均病灶主径为66.6 mm，表面积为3066 mm2。平均手术时间为 55.2 分钟，平均切除速度为 61.4 mm2/min。En Bloc 和 R0 切除率分别为 100% 和 98%。94% 的病例切除是治愈的。发生 4 例穿孔（8%），所有穿孔均通过内镜闭合，无需手术。发现 1 例迟发性出血（2%）。这项前瞻性评估证实了 ATRACT 设备自适应牵引策略用于高切除速度结直肠 ESD 的有效性和安全性。