Double-clip traction for colonic endoscopic submucosal dissection: a multicenter study of 599 consecutive cases (with video).

Background and aims Colonic ESD is particularly challenging and limited to few experts’ centers. We recently conducted a pilot study about improvement of colonic ESD thanks to a systematic use of a countertraction device (double-clip traction with rubber band (DCT-ESD). Materials and methods French prospective multicenter study between March 2017 and September 2019, including all consecutive cases of naive colonic ESD. Since the first case of DCT ESD in March 2017, all colonic ESD cases have been performed using DCT-ESD strategy in the 3 centers involved in the study. Results Five hundred ninety-nine lesions with a mean size of 53 mm were included in this study, resected by 5 operators in 3 centers. The en-bloc, R0 and curative resection rates were respectively 95.7%, 83.5%, and 81.1%. The adverse event rates were 4.9% for perforation and 4.2% for postprocedure bleeding. Between 2017 and 2019, the rates of R0 and curative resections increased significantly, from 74.7% in 2017 to 88.4% in 2019 (p = 0.003) and from 72.6% in 2017 to 86.3% in 2019 (p = 0.004), respectively. Procedure duration and speed of resection were 62.4 minutes and 39.4 mm2/min respectively. No difference was noted between operators. Conclusion The DCT-ESD is a safe and reproducible technique, allowing to obtain carcinological results comparable to those of the large Japanese teams with speed of resection twice higher as previous reported studies. The DCT strategy is promising, cheap and seems to be reproducible. Physicians performing colonic ESD should be aware of this promising tool to improve their results in ESD.