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

Figure 13  Spring-and-loop with clip-assisted gastric endoscopic submucosal dissection. A: Forward endoscopic position; B: Retroflexed endoscopic position; C: The endoscope has the possibility to stretch the spring, resulting in a loss of spring elasticity in the retroflexed endoscopic position. In this situation, the modified attachment method that we described in detail in the previous papers[9-11] is required to avoid this problem. 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].