“String-to-ring” traction technique for endoscopic submocosal dissection in the treatment of rectal tumors

Abstract

The results for “string-to-ring” ESD and conventional ESD were compared in present study. The “string-to-ring” method was developed to create traction using a thread, fixed to the edge of the tumor, that is moved through a ring, located on the clip on the opposite wall. The study included 41 ESDs of the lesions larger than 3 cm in the rectum, that were performed from October 2016 to June 2021. Patients were divided into two groups (“string-to-ring” ESD, n = 19; conventional ESD, n = 22). Time of the procedure and the frequency of complications were evaluated. Analyzing the obtained data, the “string-to-ring” method allowed to shorten the operation time (from 85,8 ± 17,5 to 63,6 ± 15,3 min), reduce the rate of intraoperative bleeding and perforations from 19% to 0%. At the conclusion, ESD with “string-to-ring” traction—a promising technique with potential for clinical application. The advantage of this method provide better visualizing the submucosal layer due to the direction of gravity. This method facilitates ESD, reduces procedure time and the number of intraoperative complications—bleeding and perforation.