Post written by Tomoya Kimura, MD, from NTT Medical Center Tokyo, Tokyo, Japan.

We introduce the pinch technique, a novel and effective traction method for endoscopic submucosal dissection in large colorectal lesions. This technique uses the “SureClip Traction Band” (Micro-Tech, Nanjing, China) to grasp lesion edges together, representing a completely new approach. It is particularly beneficial for tubular organs such as the colon and especially useful for lesions extending beyond half the lumen’s circumference. Compared with conventional methods, it requires minimal technical intervention and can be applied to any location.

To our knowledge, there have been no reports of traction techniques achieved by gathering the dissected part itself. In cases of large lesions, larger than half the circumference of the lumen, the more the operator dissects, the more the dissected part sags, contacts the opposite wall, and loses the traction effect. However, as demonstrated in this video, with use of the pinch technique, traction on both edges of the submucosal layer was improved, enabling safe and smooth resection.

Endoscopic submucosal dissection for large colorectal lesions remains a challenging procedure. It is expected that new devices and techniques will continue to be developed, further enhancing safety of the treatment.

The pinch technique. A, A large colon lesion more than half circumferential. B, Good visibility of the submucosal layer with gravity traction. C, The dissected part contacted the opposite mucosa, reducing traction. D, Gather both ends of the dissected part. E, The pinch technique restored good traction.

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