Efficacy and safety of traction-assisted endoscopic submucosal dissection for superficial gastric neoplasms - a meta-analysis of randomized controlled trials

Sep 23, 2026

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Endoscopic submucosal dissection (ESD) for superficial gastric neoplasms is effective but technically demanding, especially during submucosal dissection where visualization and tissue tension limitations increase procedure time and complications. A comprehensive meta-analysis of randomized controlled trials compared traction-assisted ESD versus conventional ESD. Outcomes assessed procedure time, en bloc and R0 resection completeness, and safety including perforation and delayed bleeding, with prespecified subgroup analyses.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Introduction

Background and clinical challenges

Methods

Study design and outcomes

Results

Procedure time, resection quality, and adverse events

Subgroup analyses

Conclusions

Clinical implications and limitations

TYPE Original Research PUBLISHED 29 May 2026 DOI 10.3389/fonc.2026.1824135 OPEN ACCESS EDITED BY Hon Chi Yip, The Chinese University of Hong Kong, China REVIEWED BY Kazuo Shiotsuki, Kanagawa Kenritsu Gan Center, Japan Takashi Kanesaka, Osaka International Cancer Institute, Japan *CORRESPONDENCE Li Wang [wangliplagh@hotmail.com](wangliplagh@hotmail.com)[ ](wangliplagh@hotmail.com)Jing Xie [Xiejing-RFCMC@hotmail.com](Xiejing-RFCMC@hotmail.com) †These authors have contributed equally to this work RECEIVED 06 March 2026 REVISED 17 May 2026 ACCEPTED 19 May 2026 PUBLISHED 29 May 2026 CITATION Zhao Z-g, Xu W-g, Zhang R, Li X-m, Yang C, Wang L and Xie J (2026) Efﬁcacy and safety of traction-assisted endoscopic submucosal dissection for superﬁcial gastric neoplasms: a metaanalysis of randomized controlled trials. Front. Oncol. 16:1824135 . doi: 10.3389/fonc.2026.1824135 COPYRIGHT © 2026 Zhao, Xu, Zhang, Li, Yang, Wang and Xie. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Efﬁcacy and safety of tractionassisted endoscopic submucosal dissection for superﬁcial gastric neoplasms: a meta-analysis of randomized controlled trials Zhen-guang Zhao 1†, Wen-guang Xu 2†, Rui Zhang 3†, Xiao-mei Li 4, Chen Yang4, Li Wang 5* and Jing Xie 6* 1 Department of Gastroenterology, Beijing Puxiang Hospital of Traditional Chinese Medicine (TCM), Beijing, China, 2 Department of Gastroenterology, The Afﬁliated Qingdao Third People ’s Hospital of Qingdao University, Qingdao, Shandong, China, 3 Department of Emergency Medicine, Rocket Force Characteristic Medical Center, Beijing, China, 4 Laoshan Medical District of No. 971 Hospital of Chinese Navy, Qingdao, Shandong, China, 5 Department of Oncology, Sunshine Union Hospital, Weifang, China, 6 Department of Gastroenterology, Rocket Force Characteristic Medical Center, Beijing, China Background: Endoscopic submucosal dissection (ESD) remains technically demanding for superﬁcial gastric neoplasms, particularly during submucosal layer dissection which is often time-consuming and associated with procedural risks. While traction-assisted ESD has been proposed to enhance visualization and facilitate safer dissection, current evidence regarding its efﬁcacy and safety remains inconsistent. Methods: We conducted a comprehensive meta-analysis of randomized controlled trials (RCTs) comparing traction-assisted versus conventional ESD for superﬁcial gastric neoplasms. Primary outcome was procedure time, with secondary outcomes were resection completeness (en bloc and R0 rates) . Safety outcomes focused on adverse events (perforation and delayed bleeding) . Subgroup analyses were performed by lesion size, lesion location, operator experience level and study design. Results: Seven RCTs involving 1476 patients were included. Meta-analysis demonstrated that traction-assisted ESD signiﬁcantly reduced procedure time compared to conventional ESD (SMD: -0. 23, 95% CI: -0.44 to-0. 02; P = 0 . 034), with particularly pronounced beneﬁts for lesions ≤20mm (SMD: -0.39, 95% CI:-0. 69 to-0. 09, P = 0 . 011) and those located at the greater curvature of the upper/ middle stomach (SMD: -0. 58, 95% CI: -0. 98 to-0. 19; P = 0 . 004) . However, the beneﬁt was operator-dependent: traction-assisted ESD signiﬁcantly reduced procedure time in beginners (SMD: -0. 22, 95% CI: -0.40 to -0. 04; P = 0 . 019) but not in experts (SMD: -0. 08, 95% CI: -0. 22 to 0 . 06; P = 0 . 250) . Resection quality remained comparable between groups, with similar en bloc (RR: 1 . 00, 95% CI: 0 .99-1. 01; P = 1 . 00

FAQs

Did traction-assisted ESD change safety outcomes like perforation or delayed bleeding?

Traction-assisted ESD reduced perforation risk substantially while maintaining a comparable delayed bleeding rate. Resection quality indicators (en bloc and R0 rates) were similar between groups.

Sep 23, 2026

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