ASGE-JGES Endoscopic Submucosal Dissection ESD (On-demand) | October 2025-LAB - Traction with ProdiGI

Video Transcription

Video Summary

This video transcript covers a hands-on training session on advanced endoscopic submucosal dissection (ESD) techniques, focusing on the use of traction rubber band methods and insulated tip (IT) knives. The instructors demonstrate marking lesions, scope navigation, and submucosal injections to facilitate effective dissection. They emphasize the growing importance of traction in ESD, usually applied after a full circumferential incision and some trimming to create a flap, enhancing tissue tension and exposure for safer, more efficient cutting.<br /><br />Different caps and knives are discussed, including the Microtech gold knife and distinctions between IT knife types—IT2 and IT nano—highlighting their design differences and suitability based on lesion location (gastric, esophageal, colonic). The training includes practical demonstrations of deploying traction devices using clips and rubber bands to pull tissue, improving visualization and access.<br /><br />Audience questions address preferred techniques for large rectal ESDs in gravity-dependent areas, with traction favored over underwater methods in many cases. Closure methods for ESD defects are discussed, noting that while suturing provides more secure closure for larger defects, no definitive comparative evidence exists yet. Clips and devices like X-TAC are also used for tissue approximation during closure. The session reinforces modern ESD practices combining traction and appropriate instruments to optimize procedural safety and outcomes.

Keywords

endoscopic submucosal dissection

traction rubber band

insulated tip knife

lesion marking

submucosal injection

Microtech gold knife

ESD closure techniques

traction devices