Multitraction point strategy for endoscopic submucosal dissection in managing difficult colorectal lesions.

Background and Aims: Colorectal endoscopic submucosal dissection (ESD) enables en bloc resection and comprehensive histopathologic assessment; however, it can be technically challenging, particularly with large or unfavorably located lesions. The traction method has shown superior outcomes compared with the conventional technique, yet a single-point traction may be inadequate in bulky lesions. This study aimed to report the outcomes of the multitraction point (MTP) technique in a video series. Methods: This video presents a case series of 3 patients in whom MTP was successfully performed, achieving en bloc resection without adverse events. Results: We present 3 cases of large laterally spreading tumors in the ascending colon and/or cecum, where a MTP strategy was performed. In each case, the traction points were strategically placed to optimize submucosal plane exposure, facilitating dissection without risk of deep mural injury. All lesions were completely resected en bloc with R0 margins, and final pathology confirmed tubulovillous adenomas on all lesions. Conclusions: These cases highlight the safety and efficacy of MTP in achieving curative resection in anatomically challenging colorectal ESD. The MTP approach may serve as a valuable technique, particularly when other methods are not feasible. Further studies are warranted to assess its generalizability and long-term outcomes.