Efficacy and safety of traction-assisted endoscopic submucosal dissection for superficial gastric neoplasms: a meta-analysis of randomized controlled trials.

Background: 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. Methods: 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 ( Results: 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; Conclusions: Traction-assisted ESD appears to be an efficient and safe technique for superficial gastric neoplasms, particularly for small lesions (≤20 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.