Endoscopic submucosal dissection of appendiceal lesions by using a novel adjustable traction device: A-TRACT-2

Endoscopic submucosal dissection (ESD) allows for en bloc resection of various lesions of the GI tract.1 Nonetheless, the technical difficulty of the procedure limits its widespread adoption, especially in the appendix where the procedure remains a challenge, even for experienced operators, combining an often-bad exposition and difficult access to the submucosa, frequently compromising R0 resection. Thus, several tools, including traction devices, have been developed to assist the intervention,2-4 but they all tend to lose traction force as the intervention progresses.