Pulley traction in endoscopic submucosal dissection of lesions in the upper two-thirds of the stomach: a retrospective study (with video).

[BACKGROUND] Endoscopic submucosal dissection (ESD) in the upper and middle thirds of the stomach is technically challenging. There are few reports on the use of pulley traction (PT), which involves using orthodontic rubber bands and dental floss to assist with ESD, in this area. We aimed to explore the efficacy of PT-ESD in this region and compare it with conventional ESD (C-ESD).

[METHODS] One hundred ninety-seven patients who underwent ESD for lesions located in the upper and middle parts of the stomach was conducted. There were 40 cases in the PT-ESD group and 157 in the C-ESD group. The primary outcome measure was dissection speed.

[RESULTS] Prior to propensity score matching (PSM), the lesion size and specimen diameter were larger in the PT-ESD group than in the C-ESD group. The PT-ESD group also experienced a longer procedure time (78.5 ± 28.7 vs. 64.9 ± 44.0 min, P = 0.02). However, the PT-ESD group had a significantly faster dissection speed (20.8 [IQR, 16.4, 30.6] vs. 9.4 [IQR, 6.0, 13.1] mm/min, P < 0.001). There were no statistically significant differences in en bloc resection, R0 resection rate, adverse events or pathological results. PSM matched 30 pairs of patients. Although the long diameter of the specimens in the PT-ESD group was larger, the procedure time for both groups was comparable, and the dissection speed of the PT-ESD group remained faster (P < 0.001).

[CONCLUSIONS] The studied pulley traction method demonstrated a good dissection speed and an acceptable complication rate for lesions in the upper and middle thirds of the stomach. It is a feasible and safe traction method.