CLIP-WITH-LINE TRACTION METHOD FOR ESOPHAGEAL ENDOSCOPIC SUBMUCOSAL DISSECTION

Abstract

Endoscopic submucosal dissection (ESD) is widely used as minimally invasive treatment for superficial early esophageal cancer. Various traction methods have been developed to overcome the technical difficulties encountered during submucosal dissection. Esophageal ESD is associated with a high risk of perforation, and traction methods are particularly important to improve submucosal visualization and ensure a safe and effective procedure. The clip-with-line traction method is the simplest and easiest among the various traction methods available in clinical practice. After creation of an incision involving the entire circumference, the clip, which is tied using dental floss, is attached to the oral aspect of the resected mucosal specimen. The dental floss is pulled from the patient’s mouth, which improves tension and visualization of the submucosa and facilitates a rapid procedure. The clip-with-line traction method is also effective in challenging cases, such as fibrotic lesions or lesions covering the entire circumference of the esophagus. In our view, the clip-with-line traction method is essential to assist esophageal ESD.