2019 Volume 61 Issue 3 Pages 273-279
In endoscopic submucosal dissection (ESD), it is important to obtain a good field of view of the detached surface for safe dissection. In our department we have devised a Nylon-loop Traction method (NT method) as an inexpensive method that can be used irrespective of the characteristics of the equipment. In the NT method, after performing a peri-mucosal incision, the endoscopist hooks a nylon thread that had been tied in an annular shape of about 2 cm in diameter, around an endoscopic clip on the mucosal wall opposite of the lesion. The annular nylon thread is then hooked around a second clip that is attached to the mucosa of the lesion. Even this alone has a traction effect, and some mucosal dissection becomes easy to perform, but the essence of this method is different. If the mobility of the lesion increases due to detachment, tension is loosened only with the initial traction, and often there is no longer effective countertraction. However, because the nylon thread is in a loop shape, the endoscopist can attach more clips to the mucosal surface and hook the thread around the clips, thereby maintaining and adjusting the traction force. There is no other way to maintain the traction force on the whole than by using a string in an annular shape and using a clip like a pulley.
