Objective Numerous auxiliary traction techniques have been devised, but their effectiveness and applicability in endoscopic submucosal dissection (ESD) remain underexplored. Our systematic review and meta-analysis aimed to compare the efficacy and safety of traction-assisted ESD (TA-ESD) and conventional ESD (C-ESD) in treating early gastric cancer (EGC) and precancerous lesions (PCL). Methods We identified and selected randomized controlled trials (RCTs) and cohort studies published up to February 2025 contrasting the efficacy of TA-ESD with C-ESD. The primary outcome was procedure time. Secondary outcomes encompassed the en bloc resection rate, complete resection rate, perforation, and delayed bleeding. Pooled standardized mean difference (SMD) and risk ratio (RR) were calculated. Subgroup analysis and meta-regression were implemented by the type of traction technique, operator experience, lesion size, lesion location, and lesion position. Results Seven RCTs and thirteen cohort studies were included. The TA-ESD group had significantly shorter procedure time relative to the C-ESD group (SMD: − 0.49, 95% CI: − 0.64 ~ − 0.33, P < 0.001, I2 = 72.7%, P < 0.001). Subgroup analysis exhibited that the double-clip traction method had significantly shorter procedure time than C-ESD (SMD: − 0.62, 95% CI: − 0.78 ~ − 0.45, P < 0.001, I2 = 0.0%, P = 0.857). Both experts and trainees could shorten the procedure time with TA-ESD on gastric lesions across various sizes and locations. The TA-ESD group had a higher complete resection rate (RR: 1.02, 95% CI: 1.01 ~ 1.03, P = 0.008, I2 = 45.6%, P = 0.024) and lower perforation incidence (RR: 0.59, 95% CI: 0.37 ~ 0.96, P = 0.032, I2 = 0.0%, P = 0.999). The en bloc resection rate and incidence of delayed bleeding were similar between the two groups. Conclusion Both experts and trainees may benefit from the use of auxiliary traction techniques when performing ESD on gastric lesions of varying sizes and locations. Among various auxiliary traction techniques, the double-clip traction method is relatively effective. PROSPERO Registration The trial is registered with <a href="http://ClinicalTrials.gov">ClinicalTrials.gov</a> CRD420251010671

The efficacy and safety of traction-assisted endoscopic submucosal resection in early gastric cancer: a systematic review and meta-analysis

期刊论文
发表日期：

2026年2月23日

查看全文

Qi Zhang,
La Yi,
Yuqing Zhou,
Yanli Wang,
Shiyu Huang

摘要

Objective

Numerous auxiliary traction techniques have been devised, but their effectiveness and applicability in endoscopic submucosal dissection (ESD) remain underexplored. Our systematic review and meta-analysis aimed to compare the efficacy and safety of traction-assisted ESD (TA-ESD) and conventional ESD (C-ESD) in treating early gastric cancer (EGC) and precancerous lesions (PCL).

Methods

We identified and selected randomized controlled trials (RCTs) and cohort studies published up to February 2025 contrasting the efficacy of TA-ESD with C-ESD. The primary outcome was procedure time. Secondary outcomes encompassed the en bloc resection rate, complete resection rate, perforation, and delayed bleeding. Pooled standardized mean difference (SMD) and risk ratio (RR) were calculated. Subgroup analysis and meta-regression were implemented by the type of traction technique, operator experience, lesion size, lesion location, and lesion position.

Results

Seven RCTs and thirteen cohort studies were included. The TA-ESD group had significantly shorter procedure time relative to the C-ESD group (SMD: − 0.49, 95% CI: − 0.64 ~ − 0.33, P < 0.001, I² = 72.7%, P < 0.001). Subgroup analysis exhibited that the double-clip traction method had significantly shorter procedure time than C-ESD (SMD: − 0.62, 95% CI: − 0.78 ~ − 0.45, P < 0.001, I² = 0.0%, P = 0.857). Both experts and trainees could shorten the procedure time with TA-ESD on gastric lesions across various sizes and locations. The TA-ESD group had a higher complete resection rate (RR: 1.02, 95% CI: 1.01 ~ 1.03, P = 0.008, I² = 45.6%, P = 0.024) and lower perforation incidence (RR: 0.59, 95% CI: 0.37 ~ 0.96, P = 0.032, I² = 0.0%, P = 0.999). The en bloc resection rate and incidence of delayed bleeding were similar between the two groups.

Conclusion

Both experts and trainees may benefit from the use of auxiliary traction techniques when performing ESD on gastric lesions of varying sizes and locations. Among various auxiliary traction techniques, the double-clip traction method is relatively effective.

PROSPERO Registration

The trial is registered with ClinicalTrials.gov CRD420251010671