Post written by Masami Omae, MD, from the Division of Medicine, Department of Upper Gastrointestinal Diseases, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden.

We report a case of endoscopic submucosal dissection (ESD) using a new off-the-shelf traction device that is easy to deploy and enables easier access to the submucosa during ESD. Several devices and techniques have been described to assist ESD, but all have some limitations. This traction system has unique characteristics as its nitinol wire enables continuous tension through the procedure; it permits dynamic traction and it does not demand extra personnel after its deployment.

This traction system is easy to deploy and friendly to use and is useful for difficult ESDs. Difficlult ESDs can be safe and successful using this traction wire. This device has specific characteristics: 1) due to the thermal memory of the nitinol wire, this device maintains its half-moon shape enabling continuous tension throughout the procedure; 2) the site of mucosal traction can be modified by removing the secondary clip and placing a new one in another location in the wall; 3) it uses a dynamic technique in which additional secondary clips can be used if desired to adjust the position during ESD; 4) internal traction can be obtained, ie, there is no need for the use of strings or snares through the nose or mouth; 5) there is no need for extra personnel to handle the device after its deployment.

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