Scheme of counter-traction for Endoscopic submucosal dissection

Abstract

Endoscopic submucosal dissection (ESD) is a useful procedure for digestive tract cancer, and becoming common procedure. As the adaptation spreads, we experience many difficult cases of large lesions, ulcerative scars, and difficult to control bleeding.
For performing ESD smoothly, it is most important to keep clear view. Good counter-traction makes ESD easier. Thread-traction-method was reported in esophageal ESD. For example, thread-traction-method is very usefulness, but it has problems in durability and complication.
So, we reported an adjustable counter-traction method using suction tube, snare and clips for gastric ESD. After we insert a suction tube intranasally and attached clips to edge of lesion, we insert snare through the tube and catch the clip using snare. This method has strong durability. It is easy to repeatedly use, and makes it possible to push and pull. This point is useful for gastric ESD.
Adjustable counter-traction is one useful method to make ESD easier.