nogrЭкспериментальная и клиническая гастроэнтерологияExperimental and Clinical Gastroenterology1682-8658«Global Media Technologies»10.31146/1682-8658-ecg-201-5-110-121nogr-1994Research ArticleОБЗОРREVIEWМетодики тракции опухоли во внутрипросветной эндоскопической хирургии пищеварительного трактаTumor traction techniques in intraluminal endoscopic surgery of the digestive tracthttps://orcid.org/0000-0002-0831-0973ВербовскийА. Н.VerbovskyA. N.

Вербовский Александр Николаевич, заведующий эндоскопическим отделением

129110, г. Москва, ул. Щепкина 61/2, корпус 1

Alexander N. Verbovsky, Head of Endoscopy

129110, Moscow, st. Shchepkina, build.61/2, building 1

Verbovsky_a@mail.ruhttps://orcid.org/0000-0002-8101-2155ПироговС. С.PirogovS. S.

Пирогов Сергей Сергеевич, д. м. н., руководитель эндоскопического блока

125284, г. Москва, 2-й Боткинский пр., д. 3

Sergey S. Pirogov, MD, PhD, Head of Endoscopic Department

125284, Moscow, 2nd Botkinsky pr., build. 3

https://orcid.org/0000-0003-1663-6620ВакуроваЕ. С.VakurovaE. S.

Вакурова Елена Сергеевна, к. м. н., руководитель отделения эндоскопии

129110, г. Москва, ул. Щепкина 61/2, корпус 1

Elena S. Vakurova, Head of Endoscopy Department

129110, Moscow, st. Shchepkina, build.61/2, building 1

https://orcid.org/0000-0002-7365-6081СеменковА. В.SemenkovA. V.

Семенков Алексей Владимирович, д. м. н., руководитель онкологического отделения хирургических методов лечения; профессор кафедры онкологии, радиотерапии и реконструктивной хирургии

129110, г. Москва, ул. Щепкина 61/2, корпус 1119991, Москва, ул. Большая Пироговская, д. 2, стр.4

Alexey V. Semenkov, MD, PhD, Head of the Department of Oncologic Surgery; professor of the Department of oncology

129110, Moscow, st. Shchepkina, build.61/2, building 1119991, Moscow, Trubetskaya str., build. 8–2

https://orcid.org/0000-0002-5262-4953СетдиковаГ. Р.SetdikovaG. R.

Сетдикова Галия Равилевна, д. м. н., заведующая отделением морфологической диагностики отдела онкологии

129110, г. Москва, ул. Щепкина 61/2, корпус 1

Galiya R. Setdikova, MD, PhD, Head of the Department of Morphological Diagnostics of the Department of Oncology

129110, Moscow, st. Shchepkina, build.61/2, building 1

https://orcid.org/0000-0003-3326-8874БалалыкинА. С.BalalykinA. S.

Балалыкин Алексей Степанович, д. м. н., профессор, лауреат Государственной премии РФ, вице-президент «Общества эндоскопических хирургов России» (РОЭХ), член Правления РНО «Российское эндоскопическое общество»

129110, г. Москва, ул. Щепкина 61/2, корпус 1

Alexey S. Balalykin, MD, PhD, professor, professor of the Department of Surgery

129110, Moscow, st. Shchepkina, build.61/2, building 1

ГБУЗ МО «Московский областной научно-исследовательский клинический институт им. М. Ф. Владимирского»РоссияМ. F. Vladimirsky Moscow Regional Research and Clinical InstituteRussian FederationМосковский научно-исследовательский онкологический институт имени П. А. Герцена, филиал ФГБУ «НМИЦ Радиологии» МЗ РФРоссияP. A. Hertzen Moscow Oncology Research InstituteRussian FederationГБУЗ МО «Московский областной научно-исследовательский клинический институт им. М. Ф. Владимирского»; ФГАОУ ВО Первый МГМУ им. И. М. Сеченова Минздрава РоссииРоссияМ. F. Vladimirsky Moscow Regional Research and Clinical Institute; I. M. Sechenov First Moscow State Medical UniversityRussian Federation20220610202205110121Copyright © Вербовский А.Н., Пирогов С.С., Вакурова Е.С., Семенков А.В., Сетдикова Г.Р., Балалыкин А.С., 20222022Вербовский А.Н., Пирогов С.С., Вакурова Е.С., Семенков А.В., Сетдикова Г.Р., Балалыкин А.С.Verbovsky A.N., Pirogov S.S., Vakurova E.S., Semenkov A.V., Setdikova G.R., Balalykin A.S.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.nogr.org/jour/article/view/1994

Эндоскопическая резекция слизистой оболочки с диссекцией в подслизистом слое (ЭПД) в настоящее время является передовым методом лечения раннего рака верхних и нижних отделов пищеварительного тракта. Метод ЭПД позволяет удалять опухоли любых размеров единым блоком, в отличие от эндоскопической резекции слизистой оболочки (ЭРС), когда возможно en bloc удалять образования размером менее 20 мм. Несмотря на это преимущество, ЭПД сопровождается большим количеством перфораций и кровотечений, чем EMR. Сложная анатомическая локализация, тонкий мышечный слой стенки органа, фиброз подслизистого слоя и недостаточный опыт оперирующего эндоскописта— основные причины неполных резекций опухоли, развития осложнений и рецидивов.Разработанные методики тракции опухоли при выполнении подслизистой диссекции позволяют увеличить долю резекции единым блоком и добиться радикальности. Нами представлен широкий арсенал различных методик тракции опухоли при выполнении ЭПД. Мы отметили как преимущества, так и недостатки тракционных методик в эндоскопической внутрипросветной хирургии.

Endoscopic submucosal dissection (ESD) is currently an advanced method of treating early cancer of the upper and lower gastrointestinal tract. The ESD allows to remove tumors of any size in an en-bloc, unlike endoscopic mucosal resection (EMR), when we can remove lesions completely only less than 20 mm in size. Despite this advantage, ESD is accompanied by more perforations and bleeding than EMR. Difficult anatomical localization, an unexpressed muscle layer of the organ wall, fibrosis of the submucosal layer and insufficient experience of the operator are the main causes of incomplete resections of the tumor, the development of complications and relapses.The described methods of tumor traction during submucosal dissection allow increasing the value of en-bloc resection and achieving histologically complete resection. We have presented a wide variety of different methods of tumor traction when performing ESD. We have noted both advantages and disadvantages of traction techniques in endoscopic intraluminal surgery.

эндоскопическая резекция слизистой оболочки с диссекцией в подслизистом слоеэндоскопическая тракционная подслизистая диссекцияendoscopic submucosal dissectionendoscopic tractional submucosal dissectionReferencesPimentel-Nunes P., Dinis-Ribeiro M., Ponchon T., et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2015;47(9):829–854. doi:10.1055/s-0034–1392882Pimentel-Nunes P., Dinis-Ribeiro M., Ponchon T., et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2015;47(9):829–854. doi:10.1055/s-0034–1392882Tsujii Y., Nishida T., Nishiyama O., et al. Clinical outcomes of endoscopic submucosal dissection for superficial esophageal neoplasms: a multicenter retrospective cohort study. Endoscopy. 2015;47(9):775–783. doi:10.1055/s-0034–1391844Tsujii Y., Nishida T., Nishiyama O., et al. Clinical outcomes of endoscopic submucosal dissection for superficial esophageal neoplasms: a multicenter retrospective cohort study. Endoscopy. 2015;47(9):775–783. doi:10.1055/s-0034–1391844Kim J.S., Kim B. W., Shin I. S. Efficacy and safety of endoscopic submucosal dissection for superficial squamous esophageal neoplasia: a meta-analysis. Dig Dis Sci. 2014;59(8):1862–1869. doi:10.1007/s10620–014–3098–2Kim J.S., Kim B. W., Shin I. S. Efficacy and safety of endoscopic submucosal dissection for superficial squamous esophageal neoplasia: a meta-analysis. Dig Dis Sci. 2014;59(8):1862–1869. doi:10.1007/s10620–014–3098–2Higashimaya M., Oka S., Tanaka S., et al. Outcome of endoscopic submucosal dissection for gastric neoplasm in relationship to endoscopic classification of submucosal fibrosis. Gastric Cancer. 2013;16(3):404–410. doi:10.1007/s10120–012–0203–0Higashimaya M., Oka S., Tanaka S., et al. Outcome of endoscopic submucosal dissection for gastric neoplasm in relationship to endoscopic classification of submucosal fibrosis. Gastric Cancer. 2013;16(3):404–410. doi:10.1007/s10120–012–0203–0Oyama T. Counter Traction Makes Endoscopic Submucosal Dissection Easier. Clin Endosc. 2012;45(4):375–378. doi:10.5946/ce.2012.45.4.375Oyama T. Counter Traction Makes Endoscopic Submucosal Dissection Easier. Clin Endosc. 2012;45(4):375–378. doi:10.5946/ce.2012.45.4.375Li C.H., Chen P. J., Chu H. C., et al. Endoscopic submucosal dissection with the pulley method for earlystage gastric cancer (with video). Gastrointest Endosc. 2011;73(1):163–167. doi:10.1016/j.gie.2010.08.041Li C.H., Chen P. J., Chu H. C., et al. Endoscopic submucosal dissection with the pulley method for earlystage gastric cancer (with video). Gastrointest Endosc. 2011;73(1):163–167. doi:10.1016/j.gie.2010.08.041Okamoto K., Okamura S., Muguruma N., et al. Endoscopic submucosal dissection for early gastric cancer using a cross-counter technique. Surg Endosc. 2012;26(12):3676–3681. doi:10.1007/s00464–012–2364–7Okamoto K., Okamura S., Muguruma N., et al. Endoscopic submucosal dissection for early gastric cancer using a cross-counter technique. Surg Endosc. 2012;26(12):3676–3681. doi:10.1007/s00464–012–2364–7Okamoto K., Muguruma N., Kitamura S., Kimura T., Takayama T. Endoscopic submucosal dissection for large colorectal tumors using a cross-counter technique and a novel large-diameter balloon overtube. Dig Endosc. 2012;24 Suppl 1:96–99. doi:10.1111/j.1443–1661.2012.01264.xOkamoto K., Muguruma N., Kitamura S., Kimura T., Takayama T. Endoscopic submucosal dissection for large colorectal tumors using a cross-counter technique and a novel large-diameter balloon overtube. Dig Endosc. 2012;24 Suppl 1:96–99. doi:10.1111/j.1443–1661.2012.01264.xYamasaki Y., Takeuchi Y., Hanaoka N., et al. A novel traction method using an endoclip attached to a nylon string during colonic endoscopic submucosal dissection. Endoscopy. 2015;47 Suppl 1 UCTN: E238–239. doi:10.1055/s-0034–1391868Yamasaki Y., Takeuchi Y., Hanaoka N., et al. A novel traction method using an endoclip attached to a nylon string during colonic endoscopic submucosal dissection. Endoscopy. 2015;47 Suppl 1 UCTN: E238–239. doi:10.1055/s-0034–1391868Yamasaki Y., Takeuchi Y., Uedo N., et al. Efficacy of traction-assisted colorectal endoscopic submucosal dissection using a clip-and-thread technique: A prospective randomized study. Dig Endosc. 2018;30(4):467–476. doi:10.1111/den.13036Yamasaki Y., Takeuchi Y., Uedo N., et al. Efficacy of traction-assisted colorectal endoscopic submucosal dissection using a clip-and-thread technique: A prospective randomized study. Dig Endosc. 2018;30(4):467–476. doi:10.1111/den.13036Noda H., Ogasawara N., Koshino A., et al. Thread-Traction with a Sheath of Polypectomy Snare Facilitates Endoscopic Submucosal Dissection of Early Gastric Cancers. Gastroenterol Res Pract. 2016;2016:9415497. doi:10.1155/2016/9415497Noda H., Ogasawara N., Koshino A., et al. Thread-Traction with a Sheath of Polypectomy Snare Facilitates Endoscopic Submucosal Dissection of Early Gastric Cancers. Gastroenterol Res Pract. 2016;2016:9415497. doi:10.1155/2016/9415497Koike Y., Hirasawa D., Fujita N., et al. Usefulness of the thread-traction method in esophageal endoscopic submucosal dissection: randomized controlled trial. Dig Endosc. 2015;27(3):303–309. doi:10.1111/den.12396Koike Y., Hirasawa D., Fujita N., et al. Usefulness of the thread-traction method in esophageal endoscopic submucosal dissection: randomized controlled trial. Dig Endosc. 2015;27(3):303–309. doi:10.1111/den.12396He Y., Fu K., Leung J., et al. Traction with dental floss and endoscopic clip improves trainee success in performing gastric endoscopic submucosal dissection (ESD): a live porcine study (with video). Surg Endosc. 2016;30(7):3138–3144. doi:10.1007/s00464–015–4598–7He Y., Fu K., Leung J., et al. Traction with dental floss and endoscopic clip improves trainee success in performing gastric endoscopic submucosal dissection (ESD): a live porcine study (with video). Surg Endosc. 2016;30(7):3138–3144. doi:10.1007/s00464–015–4598–7Yoshida M., Takizawa K., Suzuki S., et al. Conventional versus traction-assisted endoscopic submucosal dissection for gastric neoplasms: a multicenter, randomized controlled trial (with video). Gastrointest Endosc. 2018;87(5):1231–1240. doi:10.1016/j.gie.2017.11.031Yoshida M., Takizawa K., Suzuki S., et al. Conventional versus traction-assisted endoscopic submucosal dissection for gastric neoplasms: a multicenter, randomized controlled trial (with video). Gastrointest Endosc. 2018;87(5):1231–1240. doi:10.1016/j.gie.2017.11.031Nomura T., Kamei A., Sugimoto S. Clip line traction method using locking clip technique for colorectal endoscopic submucosal dissection. Dig Endosc. 2019;31(3): e72-e73. doi:10.1111/den.13364Nomura T., Kamei A., Sugimoto S. Clip line traction method using locking clip technique for colorectal endoscopic submucosal dissection. Dig Endosc. 2019;31(3): e72-e73. doi:10.1111/den.13364Hirao M., Masuda K., Asanuma T., et al. Endoscopic resection of early gastric cancer and other tumors with local injection of hypertonic saline-epinephrine. Gastrointest Endosc. 1988;34(3):264–269. doi:10.1016/s0016–5107(88)71327–9Hirao M., Masuda K., Asanuma T., et al. Endoscopic resection of early gastric cancer and other tumors with local injection of hypertonic saline-epinephrine. Gastrointest Endosc. 1988;34(3):264–269. doi:10.1016/s0016–5107(88)71327–9Higuchi K., Tanabe S., Azuma M., et al. Doubleendoscope endoscopic submucosal dissection for the treatment of early gastric cancer accompanied by an ulcer scar (with video). Gastrointest Endosc. 2013;78(2):266–273. doi:10.1016/j.gie.2013.01.010Higuchi K., Tanabe S., Azuma M., et al. Doubleendoscope endoscopic submucosal dissection for the treatment of early gastric cancer accompanied by an ulcer scar (with video). Gastrointest Endosc. 2013;78(2):266–273. doi:10.1016/j.gie.2013.01.010Ahn J.Y., Choi K. D., Choi J. Y., et al. Transnasal endoscope-assisted endoscopic submucosal dissection for gastric adenoma and early gastric cancer in the pyloric area: a case series. Endoscopy. 2011;43(3):233–235. doi:10.1055/s-0030–1256037Ahn J.Y., Choi K. D., Choi J. Y., et al. Transnasal endoscope-assisted endoscopic submucosal dissection for gastric adenoma and early gastric cancer in the pyloric area: a case series. Endoscopy. 2011;43(3):233–235. doi:10.1055/s-0030–1256037Ahn J.Y., Choi K. D., Lee J. H., et al. Is transnasal endoscope-assisted endoscopic submucosal dissection for gastric neoplasm useful in training beginners? A prospective randomized trial. Surg Endosc. 2013;27(4):1158–1165. doi:10.1007/s00464–012–2567-yAhn J.Y., Choi K. D., Lee J. H., et al. Is transnasal endoscope-assisted endoscopic submucosal dissection for gastric neoplasm useful in training beginners? A prospective randomized trial. Surg Endosc. 2013;27(4):1158–1165. doi:10.1007/s00464–012–2567-yOgata K., Yanai M., Kuriyama K., et al. Double Endoscopic Intraluminal Operation (DEILO) for Early Gastric Cancer: Outcome of Novel Procedure for Endoscopic Submucosal Dissection. Anticancer Res. 2017;37(1):343–347. doi:10.21873/anticanres.11327Ogata K., Yanai M., Kuriyama K., et al. Double Endoscopic Intraluminal Operation (DEILO) for Early Gastric Cancer: Outcome of Novel Procedure for Endoscopic Submucosal Dissection. Anticancer Res. 2017;37(1):343–347. doi:10.21873/anticanres.11327Uraoka T., Ishikawa S., Kato J., et al. Advantages of using thin endoscope-assisted endoscopic submucosal dissection technique for large colorectal tumors. Dig Endosc. 2010;22(3):186–191. doi:10.1111/j.1443–1661.2010.00992.xUraoka T., Ishikawa S., Kato J., et al. Advantages of using thin endoscope-assisted endoscopic submucosal dissection technique for large colorectal tumors. Dig Endosc. 2010;22(3):186–191. doi:10.1111/j.1443–1661.2010.00992.xImaeda H., Iwao Y., Ogata H., et al. A new technique for endoscopic submucosal dissection for early gastric cancer using an external grasping forceps. Endoscopy. 2006;38(10):1007–1010. doi:10.1055/s-2006–925264Imaeda H., Iwao Y., Ogata H., et al. A new technique for endoscopic submucosal dissection for early gastric cancer using an external grasping forceps. Endoscopy. 2006;38(10):1007–1010. doi:10.1055/s-2006–925264Imaeda H., Hosoe N., Ida Y., et al. Novel technique of endoscopic submucosal dissection using an external grasping forceps for superficial gastric neoplasia. Dig Endosc. 2009;21(2):122–127. doi:10.1111/j.1443–1661.2009.00842.xImaeda H., Hosoe N., Ida Y., et al. Novel technique of endoscopic submucosal dissection using an external grasping forceps for superficial gastric neoplasia. Dig Endosc. 2009;21(2):122–127. doi:10.1111/j.1443–1661.2009.00842.xImaeda H., Hosoe N., Ida Y., et al. Novel technique of endoscopic submucosal dissection by using external forceps for early rectal cancer (with videos). Gastrointest Endosc. 2012;75(6):1253–1257. doi:10.1016/j.gie.2012.02.018Imaeda H., Hosoe N., Ida Y., et al. Novel technique of endoscopic submucosal dissection by using external forceps for early rectal cancer (with videos). Gastrointest Endosc. 2012;75(6):1253–1257. doi:10.1016/j.gie.2012.02.018Parra-Blanco A., Nicolas D., Arnau M. R., Gimeno-Garcia A.Z., Rodrigo L., Quintero E. Gastric endoscopic submucosal dissection assisted by a new traction method: the clip-band technique. A feasibility study in a porcine model (with video). Gastrointest Endosc. 2011;74(5):1137–1141. doi:10.1016/j.gie.2011.07.037Parra-Blanco A., Nicolas D., Arnau M. R., Gimeno-Garcia A.Z., Rodrigo L., Quintero E. Gastric endoscopic submucosal dissection assisted by a new traction method: the clip-band technique. A feasibility study in a porcine model (with video). Gastrointest Endosc. 2011;74(5):1137–1141. doi:10.1016/j.gie.2011.07.037Matsumoto K., Nagahara A., Ueyama H., et al. Development and clinical usability of a new traction device “medical ring” for endoscopic submucosal dissection of early gastric cancer. Surg Endosc. 2013;27(9):3444–3451. doi:10.1007/s00464–013–2887–6Matsumoto K., Nagahara A., Ueyama H., et al. Development and clinical usability of a new traction device “medical ring” for endoscopic submucosal dissection of early gastric cancer. Surg Endosc. 2013;27(9):3444–3451. doi:10.1007/s00464–013–2887–6Oung B., Rivory J., Chabrun E., et al. ESD with double clips and rubber band traction of neoplastic lesions developed in the appendiceal orifice is effective and safe. Endosc Int Open. 2020;8(3): E388-E395. doi:10.1055/a-1072–4830Oung B., Rivory J., Chabrun E., et al. ESD with double clips and rubber band traction of neoplastic lesions developed in the appendiceal orifice is effective and safe. Endosc Int Open. 2020;8(3): E388-E395. doi:10.1055/a-1072–4830Suzuki Y., Tanuma T., Nojima M., et al. Comparison of dissection speed during colorectal ESD between the novel Multiloop (M-loop) traction method and ESD methods without traction. Endosc Int Open. 2020;8(7): E840-E847. doi:10.1055/a-1161–8596Suzuki Y., Tanuma T., Nojima M., et al. Comparison of dissection speed during colorectal ESD between the novel Multiloop (M-loop) traction method and ESD methods without traction. Endosc Int Open. 2020;8(7): E840-E847. doi:10.1055/a-1161–8596Mori H., Kobara H., Nishiyama N., Fujihara S., Matsunaga T., Masaki T. Novel effective and repeatedly available ring-thread counter traction for safer colorectal endoscopic submucosal dissection. Surg Endosc. 2017;31(7):3040–3047. doi:10.1007/s00464–016–5326–7Mori H., Kobara H., Nishiyama N., Fujihara S., Matsunaga T., Masaki T. Novel effective and repeatedly available ring-thread counter traction for safer colorectal endoscopic submucosal dissection. Surg Endosc. 2017;31(7):3040–3047. doi:10.1007/s00464–016–5326–7Nomura T., Kamei A., Sugimoto S., Oyamada J. Colorectal endoscopic submucosal dissection using a clip-on-clip traction method. Endoscopy. 2018;50(8): E197-E198. doi:10.1055/a-0605–2868Nomura T., Kamei A., Sugimoto S., Oyamada J. Colorectal endoscopic submucosal dissection using a clip-on-clip traction method. Endoscopy. 2018;50(8): E197-E198. doi:10.1055/a-0605–2868Sakurazawa N., Kato S., Miyashita M., et al. An innovative technique for endoscopic submucosal dissection of early gastric cancer using a new spring device. Endoscopy. 2009;41(11):929–933. doi:10.1055/s-0029–1215191Sakurazawa N., Kato S., Miyashita M., et al. An innovative technique for endoscopic submucosal dissection of early gastric cancer using a new spring device. Endoscopy. 2009;41(11):929–933. doi:10.1055/s-0029–1215191Nagata M. Internal traction method using a springand-loop with clip (S-O clip) allows countertraction in gastric endoscopic submucosal dissection. Surg Endosc. 2020;34(8):3722–3733. doi:10.1007/s00464–020–07590–9Nagata M. Internal traction method using a springand-loop with clip (S-O clip) allows countertraction in gastric endoscopic submucosal dissection. Surg Endosc. 2020;34(8):3722–3733. doi:10.1007/s00464–020–07590–9Hijikata Y., Ogasawara N., Sasaki M., et al. Endoscopic submucosal dissection with sheath-assisted counter traction using a novel sheath for early gastric cancers. Hepatogastroenterology. 2012;59(114):353–356. doi:10.5754/hge11458Hijikata Y., Ogasawara N., Sasaki M., et al. Endoscopic submucosal dissection with sheath-assisted counter traction using a novel sheath for early gastric cancers. Hepatogastroenterology. 2012;59(114):353–356. doi:10.5754/hge11458Ritsuno H., Sakamoto N., Osada T., et al. Prospective clinical trial of traction device-assisted endoscopic submucosal dissection of large superficial colorectal tumors using the S-O clip. Surg Endosc. 2014;28(11):3143–3149. doi:10.1007/s00464–014–3572–0Ritsuno H., Sakamoto N., Osada T., et al. Prospective clinical trial of traction device-assisted endoscopic submucosal dissection of large superficial colorectal tumors using the S-O clip. Surg Endosc. 2014;28(11):3143–3149. doi:10.1007/s00464–014–3572–0Hashimoto R., Hirasawa D., Iwaki T., et al. Usefulness of the S-O clip for gastric endoscopic submucosal dissection (with video). Surg Endosc. 2018;32(2):908–914. doi:10.1007/s00464–017–5765–9Hashimoto R., Hirasawa D., Iwaki T., et al. Usefulness of the S-O clip for gastric endoscopic submucosal dissection (with video). Surg Endosc. 2018;32(2):908–914. doi:10.1007/s00464–017–5765–9Yonezawa J., Kaise M., Sumiyama K., Goda K., Arakawa H., Tajiri H. A novel double-channel therapeutic endoscope (“R-scope”) facilitates endoscopic submucosal dissection of superficial gastric neoplasms. Endoscopy. 2006;38(10):1011–1015. doi:10.1055/s-2006–944779Yonezawa J., Kaise M., Sumiyama K., Goda K., Arakawa H., Tajiri H. A novel double-channel therapeutic endoscope (“R-scope”) facilitates endoscopic submucosal dissection of superficial gastric neoplasms. Endoscopy. 2006;38(10):1011–1015. doi:10.1055/s-2006–944779Lee S.H., Gromski M. A., Derevianko A., et al. Efficacy of a prototype endoscope with two deflecting working channels for endoscopic submucosal dissection: a prospective, comparative, ex vivo study. Gastrointest Endosc. 2010;72(1):155–160. doi:10.1016/j.gie.2010.01.056Lee S.H., Gromski M. A., Derevianko A., et al. Efficacy of a prototype endoscope with two deflecting working channels for endoscopic submucosal dissection: a prospective, comparative, ex vivo study. Gastrointest Endosc. 2010;72(1):155–160. doi:10.1016/j.gie.2010.01.056Moyer M.T., Haluck R. S., Gopal J., Pauli E. M., Mathew A. Transgastric organ resection solely with the prototype R-scope and the self-approximating transluminal access technique. Gastrointest Endosc. 2010;72(1):170–176. doi:10.1016/j.gie.2010.01.019Moyer M.T., Haluck R. S., Gopal J., Pauli E. M., Mathew A. Transgastric organ resection solely with the prototype R-scope and the self-approximating transluminal access technique. Gastrointest Endosc. 2010;72(1):170–176. doi:10.1016/j.gie.2010.01.019Motohashi O. Two-point fixed endoscopic submucosal dissection in rectal tumor (with video). Gastrointest Endosc. 2011;74(5):1132–1136. doi:10.1016/j.gie.2011.07.035Motohashi O. Two-point fixed endoscopic submucosal dissection in rectal tumor (with video). Gastrointest Endosc. 2011;74(5):1132–1136. doi:10.1016/j.gie.2011.07.035Ohata K., Fu K., Shouzushima M., et al. A novel traction system for esophageal endoscopic submucosal dissection. Endoscopy. 2012;44 Suppl 2 UCTN: E410–411. doi:10.1055/s-0032–1325735Ohata K., Fu K., Shouzushima M., et al. A novel traction system for esophageal endoscopic submucosal dissection. Endoscopy. 2012;44 Suppl 2 UCTN: E410–411. doi:10.1055/s-0032–1325735Teoh A.Y.B., Chiu P. W.Y., Hon S. F., Mak T. W.C., Ng E. K.W., Lau J. Y.W. Ex vivo comparative study using the Endolift er® as a traction device for enhancing submucosal visualization during endoscopic submucosal dissection. Surg Endosc. 2013;27(4):1422–1427. doi:10.1007/s00464–012–2583-yTeoh A.Y.B., Chiu P. W.Y., Hon S. F., Mak T. W.C., Ng E. K.W., Lau J. Y.W. Ex vivo comparative study using the Endolift er® as a traction device for enhancing submucosal visualization during endoscopic submucosal dissection. Surg Endosc. 2013;27(4):1422–1427. doi:10.1007/s00464–012–2583-yYasuda M., Naito Y., Kokura S., Yoshida N., Yoshikawa T. Sa1687 Newly-Developed ESD (CSL-ESD) for Early Gastric Cancer Using Convenient and Low-Cost Lifting Method (Lifting Method Using Clips and Snares) for Lesions is Clinically Useful. Gastrointestinal Endoscopy. 2012;75: AB244. doi:10.1016/j.gie.2012.04.207Yasuda M., Naito Y., Kokura S., Yoshida N., Yoshikawa T. Sa1687 Newly-Developed ESD (CSL-ESD) for Early Gastric Cancer Using Convenient and Low-Cost Lifting Method (Lifting Method Using Clips and Snares) for Lesions is Clinically Useful. Gastrointestinal Endoscopy. 2012;75: AB244. doi:10.1016/j.gie.2012.04.207Yoshida N., Doyama H., Ota R., et al. Effectiveness of clip-and-snare method using pre-looping technique for gastric endoscopic submucosal dissection. World J Gastrointest Endosc. 2016;8(12):451–457. doi:10.4253/wjge.v8.i12.451Yoshida N., Doyama H., Ota R., et al. Effectiveness of clip-and-snare method using pre-looping technique for gastric endoscopic submucosal dissection. World J Gastrointest Endosc. 2016;8(12):451–457. doi:10.4253/wjge.v8.i12.451Zhang Q., Yao X., Cai J. Q., Zhang B. H., Wang Z. Snare combined with endoclips in endoscopic submucosal dissection with mucosal traction for gastroesophageal neoplasia. J Gastroenterol Hepatol. 2019;34(6):1049–1057. doi:10.1111/jgh.14561Zhang Q., Yao X., Cai J. Q., Zhang B. H., Wang Z. Snare combined with endoclips in endoscopic submucosal dissection with mucosal traction for gastroesophageal neoplasia. J Gastroenterol Hepatol. 2019;34(6):1049–1057. doi:10.1111/jgh.14561Zhang Q., Wang Z. Cannula-guided snare with endoclip to assist in endoscopic submucosal dissection: an in vivo animal study. Minim Invasive Ther Allied Technol. 2019;28(4):227–233. doi:10.1080/13645706.2018.1518244Zhang Q., Wang Z. Cannula-guided snare with endoclip to assist in endoscopic submucosal dissection: an in vivo animal study. Minim Invasive Ther Allied Technol. 2019;28(4):227–233. doi:10.1080/13645706.2018.1518244Kondo H., Gotoda T., Ono H., et al. Percutaneous traction-assisted EMR by using an insulation-tipped electrosurgical knife for early stage gastric cancer. Gastrointest Endosc. 2004;59(2):284–288. doi:10.1016/s0016–5107(03)02533–1Kondo H., Gotoda T., Ono H., et al. Percutaneous traction-assisted EMR by using an insulation-tipped electrosurgical knife for early stage gastric cancer. Gastrointest Endosc. 2004;59(2):284–288. doi:10.1016/s0016–5107(03)02533–1von Delius S., Karagianni A., von Weyhern C. H., et al. Percutaneously assisted endoscopic surgery using a new PEG-minitrocar for advanced endoscopic submucosal dissection (with videos). Gastrointest Endosc. 2008;68(2):365–369. doi:10.1016/j.gie.2008.02.093von Delius S., Karagianni A., von Weyhern C. H., et al. Percutaneously assisted endoscopic surgery using a new PEG-minitrocar for advanced endoscopic submucosal dissection (with videos). Gastrointest Endosc. 2008;68(2):365–369. doi:10.1016/j.gie.2008.02.093Chen P.J., Huang W. C., Wang H. P., et al. Percutaneous transgastric traction-assisted esophageal endoscopic submucosal dissection: a randomized controlled trial in a porcine model. Scand J Gastroenterol. 2012;47(11):1386–1393. doi:10.3109/00365521.2012.725091Chen P.J., Huang W. C., Wang H. P., et al. Percutaneous transgastric traction-assisted esophageal endoscopic submucosal dissection: a randomized controlled trial in a porcine model. Scand J Gastroenterol. 2012;47(11):1386–1393. doi:10.3109/00365521.2012.725091Nishiwaki S., Araki H., Shirakami Y., et a l. Transgastrostomic endoscopy-assisted endoscopic submucosal dissection. Endoscopy. 2009;41 Suppl 2: E13. doi:10.1055/s-2008–1077713Nishiwaki S., Araki H., Shirakami Y., et a l. Transgastrostomic endoscopy-assisted endoscopic submucosal dissection. Endoscopy. 2009;41 Suppl 2: E13. doi:10.1055/s-2008–1077713Kobayashi T., Gotohda T., Tamakawa K., Ueda H., Kakizoe T. Magnetic anchor for more effective endoscopic mucosal resection. Jpn J Clin Oncol. 2004;34(3):118–123. doi:10.1093/jjco/hyh025Kobayashi T., Gotohda T., Tamakawa K., Ueda H., Kakizoe T. Magnetic anchor for more effective endoscopic mucosal resection. Jpn J Clin Oncol. 2004;34(3):118–123. doi:10.1093/jjco/hyh025Ye L., Yuan X, Pang M., et al. Magnetic bead-assisted endoscopic submucosal dissection: a gravity-based traction method for treating large superficial colorectal tumors. Surg Endosc. 2019;33(6):2034–2041. doi:10.1007/s00464–019–06799–7Ye L., Yuan X, Pang M., et al. Magnetic bead-assisted endoscopic submucosal dissection: a gravity-based traction method for treating large superficial colorectal tumors. Surg Endosc. 2019;33(6):2034–2041. doi:10.1007/s00464–019–06799–7Dobashi A., Storm A. C., Wong Kee Song L. M., et al. An internal magnet traction device reduces procedure time for endoscopic submucosal dissection by expert and non-expert endoscopists: ex vivo study in a porcine colorectal model (with video). Surg Endosc. 2019;33(8):2696–2703. doi:10.1007/s00464–019–06817–8Dobashi A., Storm A. C., Wong Kee Song L. M., et al. An internal magnet traction device reduces procedure time for endoscopic submucosal dissection by expert and non-expert endoscopists: ex vivo study in a porcine colorectal model (with video). Surg Endosc. 2019;33(8):2696–2703. doi:10.1007/s00464–019–06817–8Matsuzaki I., Hattori M., Hirose K., et al. Magnetic anchor-guided endoscopic submucosal dissection for gastric lesions (with video). Gastrointest Endosc. 2018;87(6):1576–1580. doi:10.1016/j.gie.2018.01.01Matsuzaki I., Hattori M., Hirose K., et al. Magnetic anchor-guided endoscopic submucosal dissection for gastric lesions (with video). Gastrointest Endosc. 2018;87(6):1576–1580. doi:10.1016/j.gie.2018.01.01

The authors declare that there are no conflicts of interest present.