REACT System Best Practices

Expert tips and techniques from experienced endoscopists for optimal REACT system utilization

Lesion Preparation for Traction

Before applying the REACT device, adequate lesion preparation is essential to facilitate optimal traction attachment. This can be achieved through two main approaches:

Option 1: Complete Circumferential Incision

Complete circumferential incision followed by trimming of the lesion edges to ensure sufficient mobility. This method is suitable for smaller lesions where complete incision can be safely performed.

Option 2: Burrowing Technique

Particularly for larger lesions, small submucosal pockets ("burrows") are created at predefined points around the lesion. The number and positioning match the intended traction points.

Burrowing Technique Details

Creating Burrows

  1. Perform focal submucosal dissection using injection and electrosurgical knife
  2. Apply soft coagulation markings at each burrow site as visual guides
  3. Create burrows equidistantly around the lesion (e.g., 5 burrows for REACT-5)
  4. In the colon, place at least 2 burrows on the easily accessible anal side

Pro Tip: Optimize lesion positioning by orienting it in the anti-gravity position whenever possible to prevent fluid pooling in the dissection plane.

Device Deployment and Attachment Protocol

1Introduction of the Device

  • Advance standard endoscopic clip through working channel without REACT
  • Use clip to grasp REACT device and pull into endoscope tip for controlled positioning

2Initial Attachment to Lesion

Attach first pink or orange band to burrowed point on lesion:

If Endoscope Stable:

Position clip perpendicular to lesion edge, open, slide band under lesion, then close clip

If Endoscope Unstable:

Use rapid open-and-close maneuver to secure band quickly

Critical: Lift clip slightly before closure to confirm muscularis propria is not grasped

3Complete Peripheral Attachment

Attach remaining pink and orange bands sequentially around the lesion

4Final Fixation

Attach purple fixation band to muscle fold or sufficient mucosal tissue on opposite wall

Advanced Traction Adjustment Techniques

Increasing Traction

Double Fixation

Attach green linking band to same site as purple fixation band to significantly increase traction force

Midpoint Traction (White Fox Band)

For large lesions:

  1. Place clip on underside of lesion at midpoint
  2. Attach white band to clip
  3. Hook white band onto green central ring
  4. Adjust tension dynamically

Additional Traction Points

Create new burrow, attach band with clip, then hook onto green central ring

Special Techniques

Pulley System for Large Cavities

For stomach or rectum procedures:

  1. Attach surgical suture to purple fixation band
  2. Use white clip to attach white band to opposite wall
  3. Create pulley system with external fixation wire
  4. Adjust traction by pulling suture externally

Best For: Large anatomical spaces with limited tissue anchoring points

Safe Device Removal Protocol

Important: Do not use REACT to remove the lesion - risk of tearing at attachment points

Removal Steps

  1. 1

    Detach Purple and Green Bands

    Remove attachment clips using standard snare

  2. 2

    Retrieve Lesion

    Use standard retrieval device for safe extraction

  3. 3

    Remove Peripheral Bands

    Prize apart clips on pink and orange bands

  4. 4

    Check Underside

    Remove any additional clips placed on lesion underside

Goal: Complete removal of all REACT components while preserving adequate margin for histopathologic evaluation

Additional Tips for Success

Patient Preparation

  • •Ensure adequate bowel preparation for optimal visibility
  • •Consider antispasmodic agents to reduce colonic motility
  • •Maintain stable patient positioning throughout procedure
  • •Monitor insufflation levels to prevent over-distension

Equipment Optimization

  • •Pre-assemble multiple REACT devices before procedure
  • •Keep extra clips readily available for adjustments
  • •Use transparent cap for better visualization
  • •Ensure clip applicator is functioning smoothly

Troubleshooting Common Issues

  • •Band slippage: Check clip closure and tissue grasp
  • •Insufficient traction: Consider double fixation technique
  • •Poor visualization: Reposition device or adjust angle
  • •Clip detachment: Verify adequate tissue in clip before closure

Pro Tips from Expert Endoscopists

For Beginners

  1. Start with smaller lesions (20-30mm) to build confidence
  2. Practice band assembly before the procedure
  3. Use REACT-3 configuration initially for simplicity
  4. Take time with clip placement - precision matters more than speed
  5. Don't hesitate to reposition clips if needed

For Advanced Users

  1. Experiment with asymmetric band configurations for irregular lesions
  2. Master the White Fox Band technique for challenging locations
  3. Develop personal preferences for band tension based on tissue type
  4. Consider prophylactic clip placement for anticipated difficult areas
  5. Combine REACT with other techniques for complex cases

Quick Reference Guide

Key Success Factors

  • ✓Proper lesion preparation
  • ✓Anti-gravity positioning
  • ✓Avoid grasping muscularis
  • ✓Secure fixation points

Common Pitfalls

  • ✗Insufficient burrow depth
  • ✗Weak fixation anchor
  • ✗Using REACT for retrieval
  • ✗Forgetting underside clips

Advanced Tips

  • ★Double fixation for large lesions
  • ★White Fox Band for midpoint
  • ★Pulley system in cavities
  • ★Dynamic tension adjustment