{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T11:16:37Z","timestamp":1789125397053,"version":"build-2803163510"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"10","license":[{"start":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T00:00:00Z","timestamp":1755648000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T00:00:00Z","timestamp":1755648000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Surg Endosc"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>The effects of traction direction in traction-assisted gastric endoscopic submucosal dissection (ESD) are underexplored. The clip-with-line (CWL) and spring-and-loop with clip (SLC) are unidirectional and direction-selectable traction devices, respectively. This study compared the procedure-related outcomes of CWL-assisted ESD (CWL-ESD) and SLC-assisted ESD (SLC-ESD) for superficial gastric neoplasms (SGNs).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>This single-center randomized controlled trial included patients with SGNs who were randomly assigned to undergo CWL-ESD or SLC-ESD performed by an expert. The traction direction was classified as proximal, diagonally proximal, vertical, diagonally distal, or distal. Vertical traction (VT) was selected for SLC-ESD using the direction-selectable traction function. The primary endpoint was the median ESD time. The secondary endpoints included dissection speed. Multiple regression analysis was used to identify factors affecting ESD time.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Overall, 105 patients who underwent SLC-ESD (<jats:italic>n<\/jats:italic> = 52) or CWL-ESD (<jats:italic>n<\/jats:italic> = 53) between August 2020 and April 2023 were included in the analysis. The median ESD time was significantly shorter in the SLC-ESD group than in the CWL-ESD group (26.0 vs. 40.5 min; <jats:italic>P<\/jats:italic> = 0.015). The median dissection speed was significantly faster in the SLC-ESD group than in the CWL-ESD group (24.9 vs. 18.2 mm<jats:sup>2<\/jats:sup>\/min; <jats:italic>P<\/jats:italic> = 0.001). The traction direction significantly differed between the groups (<jats:italic>P<\/jats:italic> &lt; 0.001), as VT was selected in all cases in the SLC-ESD group, compared with that in 11.3% of cases in the CWL-ESD group. Multiple regression analysis revealed that VT was independently associated with a shorter ESD time (<jats:italic>P<\/jats:italic> &lt; 0.001). The complete resection rate did not differ between the groups (98.1% vs. 96.2%; <jats:italic>P<\/jats:italic> = 1.000). Adverse event rates were not different between the groups.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>A direction-selectable traction device may be more effective than a unidirectional traction device in gastric ESD.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Graphical abstract<\/jats:title>\n          <\/jats:sec>","DOI":"10.1007\/s00464-025-12102-8","type":"journal-article","created":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T16:28:38Z","timestamp":1755707318000},"page":"6970-6981","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Unidirectional versus direction-selectable traction device in gastric endoscopic submucosal dissection: a randomized controlled trial"],"prefix":"10.1007","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5697-5953","authenticated-orcid":false,"given":"Mitsuru","family":"Nagata","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masayuki","family":"Namiki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoaki","family":"Fujikawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiromi","family":"Munakata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,20]]},"reference":[{"key":"12102_CR1","doi-asserted-by":"publisher","first-page":"987","DOI":"10.1055\/s-2006-944716","volume":"38","author":"A Imagawa","year":"2006","unstructured":"Imagawa A, Okada H, Kawahara Y, Takenaka R, Kato J, Kawamoto H, Fujiki S, Takata R, Yoshino T, Shiratori Y (2006) Endoscopic submucosal dissection for early gastric cancer: results and degrees of technical difficulty as well as success. 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