[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-377625-105":59,"doc-detail-377625-en":135},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":128,"head_meta":130,"extra_data":132,"updated_unix":134},105,"en","impact-of-traction-direction-in-traction-assisted-gastric-endoscopic-submucosal-dissection-with-videos","Impact of Traction Direction in Traction-Assisted Gastric Endoscopic Submucosal Dissection - with Videos","","Traction direction effects in traction-assisted gastric endoscopic submucosal dissection (ESD) have not been sufficiently studied. A clip with line (CWL) provides classic single-directional traction, while a spring and loop with clip (SLC; S–O clip) enables multidirectional traction. This retrospective single-expert comparison evaluated CWL-ESD versus SLC-ESD using traction-direction classification, propensity score matching, and procedure time as the primary endpoint.",{"@graph":69,"@context":127},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/impact-of-traction-direction-in-traction-assisted-gastric-endoscopic-submucosal-dissection-with-videos/377625/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/impact-of-traction-direction-in-traction-assisted-gastric-endoscopic-submucosal-dissection-with-videos/377625.png","ImageObject",300,407,{"name":92,"@type":93},"MrHarris58","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-31","2026-09-24",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",12,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119,123],{"name":110,"@type":111,"acceptedAnswer":112},"What devices were compared in this study?","Question",{"text":113,"@type":114},"The study compared CWL-assisted gastric ESD (CWL-ESD) using a clip with line and SLC-assisted gastric ESD (SLC-ESD) using a spring and loop with clip (S–O clip).","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How was traction direction classified?",{"text":118,"@type":114},"Traction direction was categorized based on endoscopic findings into five groups: proximal, diagonally proximal, vertical, diagonally distal, and distal.",{"name":120,"@type":111,"acceptedAnswer":121},"What was the primary outcome and what did the results show?",{"text":122,"@type":114},"The primary outcome was gastric ESD procedure time. After propensity score matching, the SLC-ESD group had a significantly shorter median procedure time than the CWL-ESD group (28.3 vs 51.0 min, P=0.022).",{"name":124,"@type":111,"acceptedAnswer":125},"Did the traction approach affect resection safety?",{"text":126,"@type":114},"En bloc resection was achieved without perforation in all patients in both CWL-ESD and SLC-ESD groups.","https://schema.org",{"og:url":83,"og:type":129,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":131,"canonical":83},"index,follow",{"doc_id":133,"site_id":62},377625,1790468362,{"code":4,"msg":5,"data":136},{"doc_id":133,"user_id":137,"nickname":92,"user_avatar":138,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":139,"file_id":140,"file_url":141,"file_type":142,"file_size":143,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":144,"language":145,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":146,"faqs":147,"seo_title":148,"seo_description":67,"update_tm":149,"read_time":150},687212988360,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Digestive Diseases and Sciences (2023) 68:2531–2544  \n[https://doi.org/10.1007/s10620-023-07870-z](https://doi.org/10.1007/s10620-023-07870-z)  \nImpact of Traction Direction in Traction‑Assisted Gastric Endoscopic Submucosal Dissection (with Videos)  \nMitsuru Nagata1 · Masayuki Namiki2 · Tomoaki Fujikawa2 · Hiromi Munakata2  \nReceived: 30 November 2022 / Accepted: 3 February 2023 / Published online: 28 February 2023 © The Author(s) 2023  \nAbstract  \nBackground The impact of traction direction in traction-assisted gastric endoscopic submucosal dissection (ESD) has not been adequately investigated. A clip with line (CWL) is a classical single-directional traction device. In contrast, a spring and loop with clip (SLC; S–O clip) is a newly developed multidirectional traction device.  \nAims To investigate the impact of traction direction in gastric ESD by comparing the procedure-related outcomes of CWLassisted ESD (CWL-ESD) and SLC-assisted ESD (SLC-ESD) .  \nMethods We retrospectively examined 140 patients with superficial gastric neoplasms who underwent SLC-ESD or CWLESD by a single ESD expert during November 2017–September 2020. The traction direction was classified based on the endoscopic finding in the following five categories: proximal, diagonally proximal, vertical, diagonally distal, and distal. In SLC-ESD, we set vertical traction, using the multidirectional traction function. Propensity score matching was conducted to compensate for the differences in lesion size, injection function of electrosurgical knife, ulcerative lesion, lesion location, and lesion position. The primary outcome was gastric ESD procedure time.  \nResults Propensity score matching created 42 pairs. The median gastric ESD procedure time in the SLC-ESD group was significantly shorter than that in the CWL-ESD group (28.3 min vs. 51.0 min, P = 0.022) . All traction direction in the SLCESD group was vertical, while only 16.7% in the CWL-ESD group. En bloc resection was attained without perforation in all the patients in both groups.  \nConclusion Our findings suggest that SLC can provide vertical traction, which reduces the gastric ESD procedure time.  \nGraphical Abstract  \nMultidirectional traction devices can provide vertical traction in most cases of gastric ESD, unlike single-directional traction devices. Vertical traction may reduce the gastric ESD procedure time.  \nKeywords Endoscopic submucosal dissection · Gastric ESD · Traction-assisted ESD · Clip with line · Spring and loop with clip · S–O clip  \n* Mitsuru Nagata  \n[mitsuru10jp@yahoo.co.jp](mitsuru10jp@yahoo.co.jp); mitsuru10jp@tokushukai.jp  \nExtended author information available on the last page of the article  \nIntroduction  \nEndoscopic submucosal dissection (ESD) is a minimally invasive therapy for superficial gastric neoplasms with little metastatic potential [1, 2], which facilitates en bloc resection of lesions that are hard to resect in en bloc by endoscopic mucosal resection (EMR), aiding precise pathological diagnosis and a lower risk of local recurrence [3] . Nevertheless, the gastric ESD procedure has a longer procedure time and higher perforation rate than EMR owing to technical complications, including a poor field of vision and inadequate tension for the submucosal dissection plane [4, 5] . To date, various traction methods have been developed to provide a good field of vision and adequate tension for the submucosal dissection plane, making the gastric ESD procedure easier [6–10] . However, the traction direction is limited inmost traction methods, leading to an unsatisfactory effect in some cases.  \nThe clip with line (CWL; Fig. 1) could be the first traction device, which can provide per-oral and single-directional traction in the direction in which the line is pulled [6, 11] . In gastric ESD, the traction direction in CWL-assisted ESD (CWL-ESD) changes per the lesion site because the direction in which the line is pulled is limited to the cardia; this could cause a poor field of v","cbCaieeL2XpN8aiG","https://ap.wps.com/l/cbCaieeL2XpN8aiG","pdf",2131529,14,"English","# Abstract\n## Background\n## Aims\n## Methods\n## Results\n## Conclusion\n# Introduction\n## Rationale for traction methods\n## Study hypothesis","[{\"question\":\"What devices were compared in this study?\",\"answer\":\"The study compared CWL-assisted gastric ESD (CWL-ESD) using a clip with line and SLC-assisted gastric ESD (SLC-ESD) using a spring and loop with clip (S–O clip).\"},{\"question\":\"How was traction direction classified?\",\"answer\":\"Traction direction was categorized based on endoscopic findings into five groups: proximal, diagonally proximal, vertical, diagonally distal, and distal.\"},{\"question\":\"What was the primary outcome and what did the results show?\",\"answer\":\"The primary outcome was gastric ESD procedure time. After propensity score matching, the SLC-ESD group had a significantly shorter median procedure time than the CWL-ESD group (28.3 vs 51.0 min, P=0.022).\"},{\"question\":\"Did the traction approach affect resection safety?\",\"answer\":\"En bloc resection was achieved without perforation in all patients in both CWL-ESD and SLC-ESD groups.\"}]","Impact of Traction Direction in Traction-Assisted Gastric Endoscopic Submucosal Dissection - with Videos | PDF",1790226331,35]