Guo XX, Zhang SH, Chen AJ, Chen YL, Chen FL. Efficacy and safety of pretraction-assisted endoscopic submucosal dissection for treating rectal neuroendocrine tumors. World J Gastrointest Endosc 2025; 17(9): 111734 [PMID: 40979064 DOI: 10.4253/wjge.v17.i9.111734]
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06332176
Submitted on:
September 27, 2025, 08:30
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Reader Comments:
This study addresses a key technical challenge in the treatment of rectal neuroendocrine tumors (NETs) by innovatively evaluating the advantages of pretraction-assisted endoscopic submucosal dissection (p-ESD) over conventional endoscopic submucosal dissection (c-ESD). The encouraging findings provide valuable evidence for clinical practice. Through a rigorous retrospective cohort study, the authors demonstrated that the p-ESD technique significantly shortens dissection time, improves the R0 resection rates, and reduces the risk of intraoperative bleeding and muscularis propria injury. These results strongly align with the fundamental principle of traction-assisted endoscopic submucosal dissection: enhancing safety and efficiency by improving exposure of the submucosal plane. The concept of "pretraction" – establishing traction before mucosal incision – is particularly commendable. Compared to methods applying traction after incision, this approach may provide earlier and more sustained visualization, potentially representing the key innovation leading to the superior outcomes. While fully acknowledging the value of this study, we offer the following suggestions for consideration to strengthen the manuscript further: 1. Technical standardization and learning curve: The article notes that all procedures were performed by a single expert endoscopist, ensuring consistency but raising an important question. What is the learning curve for the p-ESD technique? For less experienced operators, how challenging is it to master the timing of device placement and tension control? Future studies involving operators with varying experience levels or providing standardized procedural videos and schematic diagrams would greatly promote the dissemination of this technique. 2. Comparison with other traction techniques: the discussion appropriately cites studies where other traction methods showed less pronounced benefits for rectal lesions. This highlights the potential uniqueness of the p-ESD technique described. A more in-depth comparison of the similarities and differences between various traction methods, in terms of mechanical principles and application scenarios, would help readers better understand why the pre-traction strategy employed in this study achieves such significant results. Overall, the study by Guo et al. presents a safer and more efficient option for the minimally invasive treatment of rectal NETs. We look forward to further prospective studies from this team and other centers to validate the broad applicability of this technique and explore its standardized training protocols.