Endoscopic submucosal tunnel dissection with an elastic traction device for a circumferential superficial esophageal neoplasm

Endoscopic submucosal dissection (ESD) is an established treatment for superficial esophageal squamous cell neoplasms (SESCNs) [ 1 ] [ 2 ]. However, it is time-consuming and challenging for large SESCNs, especially circumferential lesions. Endoscopic submucosal tunnel dissection (ESTD) has been reported as an effective technique for circumferential SESCNs [ 3 ] [ 4 ]. Herein, we report a case of traction-assisted ESTD using a novel elastic traction device (Micro-Tech, Nanjing, China), consisting of a rotatable soft-tissue clip and an elastic double ring attached to the clip arm ([ Fig. 1 ]). Fig. 1 The elastic traction device. A 59-year-old man underwent ESTD for a 6-cm-long whole-circumferential SESCN at the middle thoracic region (26–32 cm; [ Fig. 2 ]). Following marking and submucosal injection, the distal and then the proximal end of the involved mucosa was cut transversely with a dual knife as per the standard ESTD method. Next, a submucosal tunnel was created from the proximal to the distal end and lateral mucosal resection was performed from proximal to distal. When adequate traction was difficult to maintain as dissection proceeded laterally ([ Fig. 3 ]), the clip-ring traction device was attached to the oral mucosal flap. Another clip was attached to the lumen at the anal side of the lesion, hooking the ring attached to the first clip. The target lesion was pulled and an adequate view of the submucosal layer presented ([ Fig. 4 ]). En bloc resection was achieved without complications. The clip-ring was cut with forceps to retrieve the resected specimen ([ Fig. 5 ]; [ Video 1 ]). Fig. 2 A 6-cm-long whole-circumferential superficial esophageal neoplasm located in the middle thoracic region. Fig. 3 Adequate traction was difficult to maintain as dissection proceeded laterally. Fig. 4 a The novel elastic traction device was deployed. b Resultant adequate view of the submucosal layer. Fig. 5 En bloc resection was achieved. Video 1 Endoscopic submucosal tunnel dissection with an elastic traction device for a circumferential superficial esophageal neoplasm. Download Video During the procedure of ESTD, the mucosa begins to sag and renders the endoscopic view unclear during lateral submucosal dissection as the tunnel is widened [ 5 ]. The novel elastic traction device allows traction to be applied in any direction as the endoscopist needs. It is also small in size and easy to handle without reinsertion of the endoscope. In conclusion, this novel elastic traction device is useful in facilitating ESTD for circumferential SESCNs. Endoscopy_UCTN_Code_TTT_1AO_2AG Endoscopy E-Videos https://eref.thieme.de/e-videos Endoscopy E-Videos is an open access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high quality video and all contributions are freely accessible online. Processing charges apply (currently EUR 375), discounts and wavers acc. to HINARI are available. This section has its own submission website at https://mc.manuscriptcentral.com/e-videos * N. Ru and E. Linghu contributed equally to this work. Publication History Article published online: 03 February 2023 © 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/) Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany