{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T05:05:13Z","timestamp":1780031113252,"version":"3.53.1"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Endoscopic submucosal dissection (ESD) remains technically demanding for superficial gastric neoplasms, particularly during submucosal layer dissection which is often time-consuming and associated with procedural risks. While traction-assisted ESD has been proposed to enhance visualization and facilitate safer dissection, current evidence regarding its efficacy and safety remains inconsistent.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a comprehensive meta-analysis of randomized controlled trials (RCTs) comparing traction-assisted versus conventional ESD for superficial gastric neoplasms. Primary outcome was procedure time, with secondary outcomes were resection completeness (\n                      <jats:italic>en bloc<\/jats:italic>\n                      and R0 rates). Safety outcomes focused on adverse events (perforation and delayed bleeding). Subgroup analyses were performed by lesion size, lesion location, operator experience level and study design.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Seven RCTs involving 1476 patients were included. Meta-analysis demonstrated that traction-assisted ESD significantly reduced procedure time compared to conventional ESD (SMD: -0.23, 95% CI: -0.44 to -0.02;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.034), with particularly pronounced benefits for lesions \u226420mm (SMD: -0.39, 95% CI: -0.69 to -0.09,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.011) and those located at the greater curvature of the upper\/middle stomach (SMD: -0.58, 95% CI: -0.98 to -0.19;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.004). However, the benefit was operator-dependent: traction-assisted ESD significantly reduced procedure time in beginners (SMD: -0.22, 95% CI: -0.40 to -0.04;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.019) but not in experts (SMD: -0.08, 95% CI: -0.22 to 0.06;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.250). Resection quality remained comparable between groups, with similar\n                      <jats:italic>en bloc<\/jats:italic>\n                      (RR: 1.00, 95% CI: 0.99-1.01;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a01.00) and R0 resection rates (RR: 1.01, 95% CI: 0.99-1.03;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.156). Importantly, traction-assisted ESD showed a 73% reduction in perforation risk (RR: 0.27, 95% CI: 0.08-0.91;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.034) while maintaining equivalent delayed bleeding rate (RR: 0.97, 95% CI: 0.59-1.60;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.920).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Traction-assisted ESD appears to be an efficient and safe technique for superficial gastric neoplasms, particularly for small lesions (\u226420 mm) and those in technically challenging locations. Notably, the procedure time benefit was significant only among less experienced operators, suggesting that traction may be most valuable for lowering the technical threshold in non-expert hands. However, given the observed sensitivity to individual studies, current evidence should be interpreted with caution. Further large-scale, multi-center RCTs are warranted to confirm these findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1824135","type":"journal-article","created":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T04:49:26Z","timestamp":1780030166000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy and safety of traction-assisted endoscopic submucosal dissection for superficial gastric neoplasms: a meta-analysis of randomized controlled trials"],"prefix":"10.3389","volume":"16","author":[{"given":"Zhen-guang","family":"Zhao","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Beijing Puxiang Hospital of Traditional Chinese Medicine (TCM)","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-guang","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The Affiliated Qingdao Third People\u2019s Hospital of Qingdao University","place":["Qingdao, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Rocket Force Characteristic Medical Center","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao-mei","family":"Li","sequence":"additional","affiliation":[{"name":"Laoshan Medical District of No. 971 Hospital of Chinese Navy","place":["Qingdao, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Yang","sequence":"additional","affiliation":[{"name":"Laoshan Medical District of No. 971 Hospital of Chinese Navy","place":["Qingdao, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Oncology, Sunshine Union Hospital","place":["Weifang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Rocket Force Characteristic Medical Center","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1111\/den.13883","article-title":"Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer (second edition)","volume":"33","author":"Ono","year":"2021","journal-title":"Dig Endosc"},{"key":"B2","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1055\/a-1811-7025","article-title":"Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 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