# Planned use of a novel Elastic Traction Device improves efficiency in colorectal endoscopic submucosal dissection: a propensity-score matched study

## TL;DR

A new Elastic Traction Device was tested for colorectal endoscopic procedures, showing improved efficiency when used early in the process.

## Contribution

The study introduces a novel Elastic Traction Device and evaluates its planned use in colorectal endoscopic submucosal dissection.

## Key findings

- Procedure time and dissection speed were not significantly different between the conventional and ETD groups.
- Early planned use of the ETD led to shorter procedure times and faster dissection compared to its use in difficult cases.
- Dissection speed improved significantly after ETD attachment.

## Abstract

Endoscopic submucosal dissection (ESD) for colorectal lesions is more challenging than for other sites, leading to the common use of traction devices to improve submucosal visibility and endoscope maneuverability. This study evaluated the outcomes and efficiency of a novel Elastic Traction Device (ETD), a rotatable and reopenable device, in colorectal ESD.

We retrospectively analyzed lesions (20–50 mm) resected at Saitama Medical University International Medical Center from July 2022 to January 2024. Lesions were divided into the conventional ESD group (C-ESD) and the ETD group (T-ESD); the T-ESD group was further split into the schedule (S) group, where ETD was planned early, and the rescue (R) group, where continued treatment was difficult. Propensity score matching (PSM) was used to balance baseline factors.

Of 260 lesions, 136 were in the C-ESD group and 124 in the T-ESD group. After PSM, 101 lesions from each group were analyzed. No significant difference was observed in procedure time (47.13 ± 36.86 vs. 52.96 ± 39.17 min, p = 0.27) or dissection speed (33.54 ± 21.38 vs. 28.38 ± 18.81 mm2/min, p = 0.07). Perforation rates were similar (4.0% vs. 5.9%, p = 0.51). In the S and R groups (58 and 33 lesions, respectively), procedure time was shorter in the S group (43.93 vs. 70.30 min, p < 0.01) with faster dissection (35.80 vs. 20.23 mm2/min, p < 0.0001). Post-ETD attachment, dissection speed improved significantly (p < 0.001).

Although the ETD did not consistently reduce procedure time or improve dissection speed, its planned and early application may offer potential benefits. Further prospective multicenter studies are needed to clarify its optimal role and clinical value in colorectal ESD.

The online version contains supplementary material available at 10.1007/s00464-025-11807-0.