A novel clip-band traction device to facilitate colorectal endoscopic submucosal dissection and defect closure

Abstract

Endoscopic submucosal dissection (ESD) allows for en bloc resection of large superficial lesions throughout the GI tract. 1,2 Adequate visualization of the submucosal dissection plane is critically important for both safety and efficacy in ESD. In traditional surgery, an assistant provides effective countertraction. However, this is not feasible with endoscopic resection, wherein countertraction is naturally absent, aside from the effects of gravity acting on the partially resected lesion.Multiple devices and techniques have been proposed and investigated to enhance visualization of the submucosal space. Internal traction methods include the use of a nylon suture, 3 the dental floss-clip traction (or clip-line) method, 4,5 the classic clip-rubber band method, 6,7 a spring-action S-O clip, 8 and the suture pulley method. 9,10 External traction devices include large double-balloon devices and robotic platforms.

Comparing a conventional and a spring-and-loop with clip traction method of endoscopic submucosal dissection for superficial gastric neoplasms: a randomized controlled trial (with videos)

“…In countries where the SLC is not available, other traction devices that allow the traction direction to be controlled vertical to the GI wall might be used as an alternative. Such traction devices include ring thread, 39 multiloop, 40 double clip and rubber band, 41 and clip-band devices, 42 which uses a thread or a band instead of a spring. However, these devices are usually utilized in colorectal ESD.…”

Use of an endoscopic flexible grasper as a traction tool for excision of polyps: preclinical trial

“…However, few traction devices can be used anywhere in the large intestine, provide real-time dynamic traction in all directions, and move independently from the endoscope, allowing for continuous direct visualization of the target plane of submucosa. The S–O clip (Zeon Medical, Tokyo, Japan), traction wire (ProdiGI™ Traction Wire, Medtronic, Ireland) and elastic band (Elastic Traction Device; Micro-Tech Endoscopy USA Inc, Ann Arbor, Mich, USA) can be used in the right colon and provide traction in all directions, but it cannot be repositioned during the procedure 20 , 21 . The clip-nylon method and the suture/clip method utilizing the FB of the double-balloon interventional platform (DEIP) can provide real-time traction, but only in a single dimension, proximal and distal/back and forth 19 , 22 , 23 .…”

Advances in traction methods for endoscopic submucosal dissection: What is the best traction method and traction direction?

“…Internal traction methods: An internal traction method can be defined as a method in which the traction device acts only inside the gastrointestinal tract. Devices for internal traction include the S–O clip[ 7 , 8 ] (Zeon Medical, Tokyo, Japan) (Figure 2 ), ring thread[ 47 ], multiloop[ 48 ], double clip and rubber band[ 49 ], and clip band[ 50 ]. The principle for generating traction is the same in these devices, as follows.…”

“…The disadvantage is that a certain distance between the anchor clip and the clip attached to the lesion is required to generate the traction force. Therefore, these devices are usually utilized for gastric ESD[ 9 - 11 ] or colorectal ESD[ 47 - 50 ].…”