Optimal traction direction in traction-assisted gastric endoscopic submucosal dissection

Figure 1 A clip-with-line was made by tying a commercially available dental floss to the arm section of the hemoclip.

Figure 2 Classification of the traction direction. A: Proximal traction; B: Diagonally proximal traction; C: Vertical traction; D: Diagonally distal traction; E: Distal traction. Citation: Reprinted from Mitsuru Nagata. Advances in traction methods for endoscopic submucosal dissection: What is the best traction method and traction direction? World Journal of Gastroenterology 2022; 28(1): 1–22. Copyright ©Mitsuru Nagata 2022. Published by Baishideng Publishing Group Inc.

Figure 3 Differences in traction direction depending on the lesion location in clip-with-line–assisted endoscopic submucosal dissection. A: Distal traction; B: Proximal traction; C: Vertical traction. Citation: Reprinted from Mitsuru Nagata. Advances in traction methods for endoscopic submucosal dissection: What is the best traction method and traction direction? World Journal of Gastroenterology 2022; 28(1): 1–22. Copyright ©Mitsuru Nagata 2022. Published by Baishideng Publishing Group Inc.

Figure 4 An S–O clip (Zeon Medical, Tokyo, Japan) was made of a 5 mm-long spring and 4 mm-long nylon loop on one side of the clip claws.