Underwater endoscopic submucosal dissection in saline solution with rubber-band countertraction for a cecal polyp extending into a diverticulum

The learning experience for endoscopic submucosal dissection in a non-academic western hospital: a single operator’s untutored, prevalence-based approach

“…Only one right colonic lesion was removed in a piecemeal fashion because of early perforation, which impeded further dissection progression. Subsequent similar lesions were resected en bloc , and success was aided by the implementation of additional techniques, such as the pocket creation method [ 12 ], the underwater saline immersion technique [ 14 ], and clip-and-band countertraction [ 14 , 17 ].…”

“…In terms of dissection strategy, circumferential incision and then standard dissection was applied for gastric and esophageal lesions, while tunneling techniques [ 12 , 13 ] were mainly applied for duodenal and colorectal lesions. Additional techniques included the saline immersion technique [ 14 ] and countertraction, such as the clip-and-snare [ 15 ], the clip-and-line and the clip-and-band techniques [ 14 , 16 ]. However, from case #40 we systematically applied standard dynamic or multifocal clip-and-band countertraction [ 16 ] to increase the dissection speed and diminish the perforation risk.…”

Wide-field endoscopic submucosal dissection for whole-antral and whole-incisura gastric multifocal dysplasia

“…These 2 cases illustrate the feasibility of wide-field whole-antral and whole-incisura ESD for extensive dysplastic areas. Despite the necessity for technical expertise, this technique can be facilitated by the application of ancillary techniques, such as dynamic and multifocal countertraction, as previously described by our team [ 2 , 3 ]. En-bloc resection offers obvious advantages in terms of decreasing recurrence risk, and obviating repeat interventions.…”

Dynamic and multifocal clip and band countertraction for endoscopic submucosal dissection

“…[1][2][3] Depending on the location, the nature of the lesion, and local availability, several techniques have been described: the clip and line technique (also known as the dental floss technique), 2,3 the clip and snare technique, 4 the suture pulley technique, 5 magnetic countertraction, 6 the s-o clip, 7 and the clip and band technique. 1,8,9 However, the application of most countertraction methods is limited by the anatomic location of the lesion. Moreover, once committed, the axis of countertraction cannot be easily modified.…”

“…Recent data have shown the efficacy of clip and band countertraction. 1 , 8 The materials needed are readily available and include conventional dental rubber bands (2D [3/16”] 3.5 ounce force) and clips.…”