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Usefulness of the Modified Clip-with-Line Method for Endoscopic Mucosal Treatment Procedure

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Koichi Soga, Takahito Shimomura, Toshio Suzuki, Tesshin Tei, Tomohiko Usui, Yoshikazu Inagaki, Kyoichi Kassai,
Kenji Itani

Nishijin Hospital, Department of Internal Medicine, Kyoto, Japan

DOI: http://dx.doi.org/10.15403/jgld.2014.1121.273.shi

Endoscopic submucosal dissection (ESD) might be difficult to perform in some cases even for experienced endoscopists. Recently, various traction methods have been introduced to facilitate ESD procedures, such as clip-with-line (CL), external forceps, clip and snare, internal traction, double scope, and magnetic anchor.
The traction procedure using the CL method enhances the visibility of the operation field during ESD. The original CL method is performed as follows: the clip with the line (e.g., dental floss) is attached to the edge of the lesion. Traction can be produced by pulling the line gently, thus achieving a sufficient visualization of the submucosal layer to identify an accurate cutting line. Herein, we present a useful modified two-CL method by pulling the appropriate normal mucosa to enhance the visibility of the operation field during ESD procedure. Thus, the traction methods, including our modified CL technique, might reduce the procedure time and complications.

Key words: clip-with-line − endoscopic submucosal dissection − traction method.

Abbreviations: CL: clip-with-line; ESD: endoscopic submucosal dissection; LGE: lower gastrointestinal endoscopy; UGE: upper gastrointestinal endoscopy.