Endoscopic submucosal dissection (ESD) allows for en bloc resection of large superficial lesions throughout the GI tract. 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, the dental floss-clip traction (or clip-line) method, the classic clip-rubber band method.
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