Post written by Yohei Koyama, MD, from the Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan.

Endoscopic submucosal dissection (ESD) has been widely accepted as a minimally invasive treatment for early colorectal neoplasms. However, cecal ESD remains a challenging treatment owing to the anatomical features of the cecum, such as the thin wall, and confrontation of the scope vertically with the muscular layer.

Therefore, performing cecal ESD requires sufficient experience and skill. Our present method enables safe endoscopic resection to be performed, even by less-experienced endoscopists.

One of the factors that makes ESD difficult is the confrontation of the scope vertically with the muscular layer. In particular, the inferior aspect of the cecum often encountered such an endoscopic view. Use of a spring-and-loop with clip (S-O clip) improved the visibility of the submucosal layer, even from a middle distance, and confrontation of the endoscope vertically with the muscular layer could be avoided.

In conclusion, ESD coupled with S-O clip traction is an effective method, particularly for lesions in the inferior aspect of the cecum, even in nonreferral center settings.

A flat elevated lesion of approximately 25 mm was detected in
the inferior aspect of the cecum.

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