Advances in traction methods for endoscopic submucosal dissection: What is the best traction method and traction direction?

Figure 12  Internal traction method using the spring-and-loop with clip (Zeon Medical, Tokyo, Japan). A: The spring-and-loop with clip (S–O clip) is attached to the lesion; B: The regular clip anchors the loop part of the S–O clip on the gastrointestinal wall; C: The extension of the spring provides traction on the lesion. The traction direction can be controlled by the anchor site. Citation: Nagata M, Fujikawa T, Munakata H. Comparing a conventional and a spring-and-loop with clip traction method of endoscopic submucosal dissection for superficial gastric neoplasms: a randomized controlled trial (with videos). Gastrointest Endosc 2021; 93(5): 1097-1109. Copyright © 2021 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc[11].