Clinical Outcomes of Traction-Assisted Endoscopic Submucosal Dissection for Prepyloric and Pyloric Neoplasms: Propensity Score Matching Analysis.

Background/Aims: Traction-assisted endoscopic submucosal dissection (TA-ESD) using dental floss substantially reduces procedural times without increasing adverse event rates. However, few studies have described the clinical outcomes following TA-ESD for prepyloric and pyloric neoplasms. Therefore, this study aimed to investigate the clinical outcomes of patients treated with TA-ESD for prepyloric and pyloric neoplasms. Methods: We retrospectively analyzed the data of 208 patients who underwent ESD for prepyloric and pyloric neoplasms between 2016 and 2021 at Pusan National University Hospital. The patients were categorized into the conventional ESD (C-ESD) (n=173) and TA-ESD (n=35) groups. One-to-two propensity score matching (PSM) was performed between both groups. Results: In the unmatched cohort, compared with the C-ESD group, the TA-ESD group had a significantly greater rate of resection defects exceeding half of the circumference of the pylorus (45.7% vs 27.2%, p=0.048), a lower complete resection rate (85.7% vs 97.1%, p=0.014), a higher positive vertical margin rate (5.7% vs 0.0%, p=0.028), and a longer procedural time (34.2±26.1 minutes vs 25.3±22.0 minutes, p=0.036). After PSM, the TA-ESD group required a significantly shorter procedural time than did the C-ESD group (30.1±18.1 minutes vs 40.4±23.7 minutes, p=0.031). No statistically significant differences were observed in other variables between the two groups. Conclusions: Compared to C-ESD, TA-ESD significantly shortened the procedural time for treating prepyloric and pyloric neoplasms. However, no significant differences were observed in the complete resection rate or in adverse events between the two groups.