Recent traction methods for endoscopic submucosal dissection

Figure 1 Clip with the line was placed on the lesion (A), and the clip and line method facilitated adequate traction (B).

Figure 2 External grasping forceps was carefully delivered with the help of the another grasping forceps (A) and the lesion was grasped by the external grasping forceps (B).

Figure 3 Schematic of our clip and snare method using a pre-looping technique. A: Endoscope with the prelooped snare; B: The clip was inserted through the working channel of the endoscope and used to grasp the mucosal flap on one side of the lesion; C: The snare, which had been pre-looped over the scope, was loosened and moved along the forceps up to the clip. We tightened the snare to grasp the clip; D: We were then able to release the clip from the forceps (from Ota et al[19]).

Figure 4 Schematic view of internal traction method (from Chen et al[22]).

Figure 5 Schematic view of double-scope method (from Fujii et al[25]).

Figure 6 Fraenkel laryngeal forceps (A) and the lesion was grasped by the Fraenkel laryngeal forceps (B).

Figure 7 Schematic view and surgical setup of endoscopic laryngopharyngeal surgery (from Tateya et al[35]).

Figure 8 Clip-and-snare method enabled pushing and pulling movements for traction. A: The lesion was pulled anally in retroflexion view using a balloon overtube in the deep colon; B: Pushing the snare to facilitate visualization of submucosal layer; C: Traction is maintained by the snare and the clip independent of the scope.