Comparison of Traction and Pocket Creation Methods for Facilitating Colorectal Endoscopic Submucosal Dissection.

Background and aim: Endoscopic submucosal dissection (ESD) offers high en bloc and R0 resection rates for large colorectal lesions. This study aims to compare the efficacy, safety, and treatment outcomes of the traction method (TM) versus the pocket creation method (PCM) in colorectal ESD.

Method: Consecutive patients undergoing colorectal ESD at a tertiary referral center from 2014 to 2024 were included. Outcomes included en bloc resection, R0 resection, curative resection, and adverse events (AE).

Results: The study included 668 patients, 50.7% of whom were females with a mean age of 63 years (SD 12). The mean diameter of the lesions was 50.4 mm (SD 23). A total of 94.8% (n = 663) of lesions were removed via en bloc resection, achieving R0 resection rate of 89.1%, and curative resection rate at 87.9%. Multivariable analysis showed that TM was linked to fourfolds increase in en bloc resection rates (OR 4.187, P = 0.001) and significantly higher R0 resection rates (OR 39.874, P < 0.001) compared to PCM. Left-sided colon lesions also had higher en bloc rates (OR 2.747, P = 0.018). TM was associated with significantly shorter dissection time than PCM (50.6 min vs 72.0 min; P < 0.001). Muscle injury was significantly more common in PCM (P = 0.012), while no differences other AE.

Conclusion: TM appears to have a higher chance of complete resection, offering shorter dissection times, while both methods have similar risks of major adverse event rates. Both techniques are good options with comparable safety profiles for colorectal ESD.