Traction-assisted colorectal endoscopic submucosal dissection (ESD) using a CLip and thread (TAC-ESD)

Use of a clip and thread is a simple and effective traction technique for endoscopic submucosal dissection (ESD) of lesions in the upper gastrointestinal tract. We can achieve good visualization of the submucosal layer during ESD by using a clip and thread. However, the conventional “clip-and-thread” technique required withdrawal of the endoscope for mounting the system; therefore, it was not fully applied for colorectal ESD. Our newly developed method - traction-assisted colorectal ESD using a clip and thread (TAC-ESD) - does not require withdrawal and reinsertion of the endoscope. Thus, we can easily apply this technique for colorectal ESD. TAC-ESD does not require special devices, and good traction can be achieved even in colorectal ESD. The strategy of TAC-ESD is simple, and it can be performed all over the world. TAC-ESD is useful for not only difficult cases but also standard cases in colorectal ESD. We can overcome the difficulties in colorectal ESD by performing TAC-ESD.