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World J Gastroenterol. Jan 7, 2022; 28(1): 1-22
Published online Jan 7, 2022. doi: 10.3748/wjg.v28.i1.1
Advances in traction methods for endoscopic submucosal dissection: What is the best traction method and traction direction?
Mitsuru Nagata
Mitsuru Nagata, Department of Endoscopy, Shonan Fujisawa Tokushukai Hospital, Kanagawa 251-0041, Japan
Author contributions: Nagata M has been associated with conception, drafting of the article, and final approval of the article.
Conflict-of-interest statement: No financial relationships with a commercial entity producing health-care related products and/or services relevant to this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Mitsuru Nagata, MD, Chief Doctor, Department of Endoscopy, Shonan Fujisawa Tokushukai Hospital, 1-5-1 Tsujidokandai, Fujisawa, Kanagawa 251-0041, Japan.
Received: March 18, 2021
Peer-review started: March 18, 2021
First decision: July 3, 2021
Revised: July 13, 2021
Accepted: December 28, 2021
Article in press: December 28, 2021
Published online: January 7, 2022
Core Tip

Core Tip: Endoscopic submucosal dissection is associated with a long procedure time and adverse events (e.g., perforation) due to technical difficulty—the absence of tension for the dissection plane and poor field of vision. Traction methods allow efficient dissection and a good field of vision. Although many traction methods have been developed, traction direction is limited in most. Each traction method has advantages and disadvantages. It is important to select an appropriate traction method to obtain proper traction direction, depending on lesion location. We discuss the characteristics of different traction methods and their effects depending on traction direction.