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Colorectal endoscopic submucosal dissection (ESD) is a difficult procedure, and its introduction to trainees has been debated. Although the criteria for performing colorectal ESD vary among institutions, it is often allowed after gaining experience performing surgeries in animals and upper gastrointestinal ESD. This pilot study aimed to compare the treatment outcomes of ESD performed by trainees using the multi-loop traction device (MLTD group) and those of conventional ESD performed by experts (control group). It also aimed to determine whether the MLTD can be used to safely introduce colorectal ESD to trainees. We included 26 colorectal ESD patients (13 in the MLTD group and 13 in the control group) treated at our hospital from October to December 2021. There were no significant differences in the procedure time (50 min vs. 30 min), dissection speed (19.9 mm2/min vs. 28.7 mm2/min), and intraoperative perforation (0% vs. 0%) of the two groups. Furthermore, the rate of ESD self-completion in the MLTD group was 100%. Therefore, the use of the MLTD allowed the safe introduction of colorectal ESD, even among endoscopists with no experience performing colorectal ESD. Consequently, the use of the MLTD may replace animal and upper gastrointestinal ESD when introducing colorectal ESD to trainees.

A 62‐year‐old woman with no past history was referred to our hospital for endoscopic treatment of a large gastric bezoar measuring 10 cm in diameter. The bezoar had a hard surface and huge volume. A tunnel was created at the center of the bezoar using electrohydraulic lithotripsy and was dilated using a through‐the‐scope balloon. The bezoar was then gradually crushed using alligator forceps and snares to decrease the risk of intestinal obstruction by the crushed bezoar fragments. The sequential use of electrohydraulic lithotripsy, alligator forceps, and snares according to the therapeutic plan enabled the endoscopic treatment of the giant gastric bezoar without surgery.

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