Post written by Qiang Zhang, MD, from the Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China.

Our team explored a modified method of assisting in ESD in the upper GI tract, with the application of a snare and endoclips (SC-ESD). We reported 3 cases: Case 1 was a gastric high-grade intraepithelial neoplasia of 11 cm × 7 cm in size, involving the gastric angle and the anterior wall of the gastric antrum-to-body junction; Case 2 was a submucosal tumor of  4 cm × 3 cm in size, involving the anterior wall of gastric antrum and the pylorus; Case 3 was  a laterally spreading tumor of 4.5 cm × 3.5 cm in size at the duodenal bulb. SC-ESD achieved en bloc resection for the 3lesions without any immediate or delayed adverse events.

It is easy for the operator to access a snare and endoclips as they are the most common endoscopic accessories in the endoscopy center, thus mucosal traction to assist in ESD, especially for difficult ESDs, could be made locally by a snare and endoclips.

SC-ESD has these operating characteristics: (1) The mucosal flap can be pulled or pushed to expose the submucosa during SC-ESD, and the strength of the force can be adjusted in real time based on the need of the operation. (2) The site of mucosal traction can be quickly and effectively adjusted during the operation by fixing the snare to the target mucosa intended for traction with the endoclips. (3) A wide range of submucosa can be exposed at the same time by fixing the snare to multiple sites of target mucosa. (4) Internal traction can be achieved through a snare and endoclips. Thus,  a snare and endoclips were feasible for assisting in ESD, especially for some difficult ESDs.

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