REACT Multipoint Elastic Traction for Colorectal ESD: A Retrospective Single-Center Feasibility Series of 59 Consecutive Cases

Background and aims: Effective traction for endoscopic submucosal dissection (ESD) should be applicable to diverse lesion morphologies and locations, adapting as dissection progresses, allow repositioning and be 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 02/2024 and 07/2025. 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: 59 colorectal lesions were resected by REACT-assisted ESD. Intraoperative perforation was reported in 3/59 cases (5.1%, 95% CI 1.1-14.1%) and delayed bleeding in 5 cases (8.5%, 95% CI 2.8-18.7%). The median dissection speed was 20.0mm2/min (IQR 14.6mm2/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, no abandonment of REACT due to non-salvageable failure). Conclusion: 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.