Post written by Mitsuru Nagata, MD, from the Department of Endoscopy, Shonan Fujisawa Tokushukai Hospital, Fujisawa-shi, Kanagawa, Japan.

A spring-and-loop with clip (SLC; S–O clip; Zeon Medical, Tokyo, Japan) has been developed as a traction device for endoscopic submucosal dissection (ESD). Its great advantage is that it can provide traction in any direction. We hypothesized that the traction vertical to the gastric wall is the most appropriate for gastric ESD, and that this procedure would be possible using the multidirectional traction function of the SLC. This study aimed to investigate whether the SLC-assisted ESD (SLC-ESD) improved the procedure-related outcomes as compared with a conventional ESD (C-ESD) in patients with superficial gastric neoplasms.

Traction methods have been developed to provide sufficient tension for the dissection plane and widen the field of vision during ESD. However, the traction direction is limited with most traction methods, and few studies have been done to explore the appropriate traction direction for gastric ESD.

In this study, the SLC-ESD reduced the median gastric ESD procedure time as compared with the C-ESD (29.1 min vs 52.6 min; P = 0.005). A direction vertical to the gastric wall was selected for the SLC-ESD using its multidirectional traction function. This outcome suggests that the traction vertical to the gastric wall facilitates gastric ESD. Although several methods can control the traction direction, further studies should explore the optimal traction direction for ESD of other organs.

The SLC can provide traction vertical to the gastric wall in both the forward and retroflexed endoscopic positions, unlike many other traction devices. Since the use of the SLC in gastric ESD has the potential for the endoscope in the retroflexed position to stretch the spring, we described a modified attachment method for the SLC to avoid interference between the endoscope and spring of the SLC. It might be a bit challenging, but it is not difficult because this procedure can be patterned depending on the lesion location.

 

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