Novel through-the-scope steerable grasper for dynamic traction reduces dissection time and technical demand in endoscopic submucosal dissection in novice endoscopists compared with clip-and-line traction method: an ex vivo randomized study

Background and Aims: Lack of effective tissue traction devices to facilitate endoscopic submucosal dissection (ESD) leads to prolonged dissection time. We aimed to study the efficacy of a novel through-the-scope steerable grasper arm (SGA) for dynamic traction compared with the clip-and-line (CL) traction method in an ex vivo setting. Methods: This was a prospective, single-center, randomized ex vivo study. In a porcine stomach model, two 25-mm circular lesions were marked. Novice endoscopists with no prior ESD experience performed ESD with both traction methods (SGA and CL). Each participant was randomized to either SGA first (study group) or CL first (control group). The primary outcome was total dissection time in minutes. Adverse events of muscle injury, perforation, mucosal injury, or fragmentation were noted. The National Aeronautics and Space Administration (NASA) task load index (TLX) was used to grade technical workload. Results: Ten subjects participated in the study, and 5 were randomized to the SGA method first. The mean dissection time was significantly shorter with SGA compared with CL (5.07 ± 2.19 minutes vs 20.07 ± 8.45 minutes, P < .001) irrespective of order of randomization. Four instances of muscle injury and 1 perforation were noted with CL and none with SGA. Mean total NASA-TLX score was significantly lower with SGA (36.1 ± 11.6) versus CL (81.5 ± 20.8) (P < .001). Conclusions: With novice endoscopists performing ESD, SGA traction leads to faster dissection time compared with the CL method with a reduced technical workload in an ex vivo setting. The SGA is a promising tool to improve efficiency and the learning curve of ESD.