Double-clip counter-traction using a rubber band is a useful and adaptive tool for colonic endoscopic submucosal dissection

Colorectal endoscopic submucosal dissection for all LSTs: histological information loss due to piecemeal EMR is no longer acceptable

“…Of course these situations are rare and studies to demonstrating outcomes of dissection in terms of survival would require huge numbers of people. However, ESD is now accessible outside Japan and in the colon, facilitated by traction techniques 11 . Therefore, it is no longer possible to consider the technique restricted to use in research by endoscopists who extremely experienced.…”

High proficiency of colonic endoscopic submucosal dissection in Europe thanks to countertraction strategy using a double clip and rubber band

“…Good exposure of the submucosal space is critical for safe and quick ESD. We previously reported the use of a simple countertraction technique that uses two clips and a rubber band 3 ; here, we report the first comparative case series of colon ESD using this countertraction technique.…”

A hematoma caused by an excessively superficial injection: go under the red bleb!

“…We then created a mucosal incision no closer than 1 cm from the hematoma. After dissection of the first submucosal fibers, we installed our previously report-ed double-clip traction device using two clips and a rubber band [2,3]. The resultant good positioning of the submucosal plane allowed access to the deep submucosal plane under the red bleb caused by the first excessively superficial injection (▶ Fig.…”