Repositionable Elastic Adaptive Customizable Traction multipoint elastic traction for colorectal endoscopic submucosal dissection: a retrospective single-center feasibility series of 59 consecutive cases (with video) - 19/02/26

Doi : 10.1016/j.gie.2025.12.273

Pieter Jan Poortmans, MD ^1,^2,^3,^{^{∗
Poortmans and Montori Joint first authors.}}, Michele Montori, MD ^1,^4,^{^{∗
Poortmans and Montori Joint first authors.}}, Lynn Karlijn Debels, MD ^1,^2,³, Maria Eva Argenziano, MD ^1,², Thomas Botelberge, MD ⁵, Anne Hoorens, MD, PhD ⁶, Sander Smeets, MD ^1,², Andrea Sorge, MD ^1,⁷, Tamas Tornai, MD, PhD ¹, Lobke Desomer, MD ^1,^2,⁸, David James Tate, MBBS, MA (Cantab), PhD ^1,^2,^⁎

¹ Department Gastroenterology and Hepatology, University Hospital Ghent, Ghent, Belgium

² Faculty of Medicine, University of Ghent, Ghent, Belgium

³ Department Gastroenterology and Hepatology, University Hospital Brussels, Brussels, Belgium

⁴ Clinic of Gastroenterology, Hepatology and Emergency Digestive Endoscopy, Università Politecnica delle Marche, Ancona, Italy

⁵ ZAS Augustinus, Department Gastroenterology, Wilrijk, Belgium

⁶ Department of Pathology, University Hospital Ghent, Ghent, Belgium

⁷ Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy

⁸ AZ Delta, Department Gastroenterology and Hepatology, Roeselare, Belgium

^∗ Corresponding author: David James Tate, MBBS, MA (Cantab), PhD. Department of Gastroenterology and Hepatology, University Hospital Ghent (UZ Gent), Corneel Heymanslaan 10, 9000 Ghent, Belgium. Department of Gastroenterology and Hepatology University Hospital Ghent (UZ Gent) Corneel Heymanslaan 10 9000 Ghent Belgium

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 19 February 2026

Abstract

Background and Aims

Effective traction for endoscopic submucosal dissection (ESD) should be applicable to diverse lesion morphologies and locations, adapting as dissection progresses, allowing repositioning, and remaining cost-effective. To meet these criteria, we developed Repositionable Elastic Adaptive Customizable Traction (REACT), a customizable, low-cost multipoint traction method assembled from orthodontic elastic bands. This study aimed to evaluate the safety and feasibility of REACT-assisted ESD in a retrospective colorectal series.

Methods

This single-center retrospective analysis included consecutive REACT-assisted ESD procedures for colorectal lesions, extracted from a prospectively maintained database at Ghent University Hospital between February 2024 and July 2025. Procedural safety was assessed by the incidence of adverse events; exploratory feasibility variables included dissection speed, R0 resection rate, and subjective improvement of submucosal access.

Results

A total of 59 colorectal lesions were resected using REACT-assisted ESD. Intraoperative perforation was reported in 3 of 59 cases (5.1%; 95% CI, 1.1%-14.1%), and delayed bleeding occurred in 5 cases (8.5%; 95% CI, 2.8%-18.7%). The median dissection speed was 20.0 mm ² /min (IQR = 14.6 mm ² /min). R0 resection was achieved in 55 cases (93.2%; 95% CI, 83.5%-98.1%). Submucosal access improved in 56 cases (94.9%) using REACT. REACT failure was salvageable in all cases (band detachment in 3/336 [0.9%] of attached bands, no band breakage, and no abandonment of REACT because of nonsalvageable failure).

Conclusions

REACT-assisted ESD was safe and feasible in this single-center retrospective analysis of a prospectively maintained consecutive colorectal ESD cohort. Prospective, multicenter studies are warranted to validate these findings and to define the optimal context for this novel traction method.

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