Facilitating Colorectal Endoscopic Submucosal Dissection: Devices and Techniques

Colorectal endoscopic submucosal dissection (ESD) is a minimally invasive endoscopic treatment that achieves a high R0 resection rate regardless of lesion size. However, its widespread adoption is limited by technical difficulties, promoting the development of various devices and techniques to support the procedure. Fundamental tools include ESD knives, transparent caps, and injection solutions. Among these, traction is especially critical for creating the mucosal flap, which is considered the most technically demanding step of ESD. Numerous traction methods and devices have been introduced, particularly for colorectal ESD. Recently, increasing attention has been paid to the use of dedicated traction devices, the pocket creation method, and buoyancy and water jet pressure under saline conditions. Nevertheless, the selection and application of these devices and techniques remain complex and underexplored. This narrative review outlines the features of available devices and techniques, discusses their appropriate selection, and provides practical tips to facilitate safe and effective colorectal ESD.