Advances in traction methods for endoscopic submucosal dissection: What is the best traction method and traction direction?

被引:70
作者
Raiteri, Alberto [1 ]
Granito, Alessandro [1 ]
Giamperoli, Alice [1 ]
Catenaro, Teresa [1 ]
Negrini, Giulia [1 ]
Tovoli, Francesco [1 ]
机构
[1] IRCCS Azienda Osped Univ Bologna, Div Internal Med Hepatobiliary & Immunoallerg Dis, Via Albertoni 15, I-40138 Bologna, Italy
关键词
Endoscopic submucosal dissection; Traction method; Countertraction; Trac-tion direction; Vertical traction; REFRACTORY CELIAC-DISEASE; T-CELL LYMPHOMA; TERM-FOLLOW-UP; CLINICAL-SIGNIFICANCE; SEROLOGICAL TESTS; IGG ANTIBODIES; DIAGNOSIS; CHILDREN; GLUTEN; GUIDELINES;
D O I
10.3748/wjg.v28.i1.154
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Endoscopic submucosal dissection (ESD) has been developed as a treatment for superficial gastrointestinal neoplasms, which can achieve en bloc resection regardless of the lesion size. However, ESD is technically difficult because endoscopists cannot bring their hand into the gastrointestinal tract, unlike surgeons in regular surgery. It is difficult to obtain sufficient tension in the dissection plane and a good field of vision. Therefore, ESD is associated with a long procedure time and a high risk of adverse events in comparison with endoscopic mucosal resection. Traction methods have been developed to provide sufficient tension for the dissection plane and a good field of vision during the ESD procedure. However, traction direction is limited in most traction methods, resulting in insufficient effect in some cases. Although traction direction is considered important, there have been few investigations of its effect. In the first half of this review, important traction methods are discussed, including traction direction. In second half, appropriate traction methods for each organ are considered. Other important considerations for traction method, such as ability to adjust traction strength, interference between traction device and endoscope, and the need for specialized devices are also discussed.
引用
收藏
页码:154 / 175
页数:22
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