Modified method of making a clip with ring‐thread for the traction of colorectal endoscopic submucosal dissection

ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) is a minimally invasive procedure for the treatment of large tumors. It was reported that the method of traction assisted ESD made colorectal ESD easier and safer. There are various methods for making a traction. The method of using a clip with ring-thread is cost-efficient, in addition, we can use the prepared various sizes of the ring-threads for various situations. The easiest method of attaching the ringthread to the clip is passing one side of the ring-thread through the crossing part of the clip arm (Video S1); however, sometimes the ring-thread drops off from the clip. When this happens, we have to pick up the ring-thread by the clip which can be cumbersome. We modified the method of attaching the ring-thread to the clip (Video S1). First, the whole ring-thread was passed through the crossing part of the clip arm (Video S1 and Fig. 1A). Then, we caught one end of the ring-thread and passed it over the other side of the loop across the base of the clip arm (Video S1 and Fig. 1B). Finally, we passed it thought the original ring-thread and tied it to the clip (Video S1 and Fig. 1C,D). In this case, we could obtain the traction distally and opening of the resection area by lifting the mucosa (Video S1). We used a standard clip (HX-610-90; Olympus, Tokyo, Japan) and 10-mm-diameter ring-thread of 5-0 nylon. We can also use other threads, such as silk or dental floss. This modified technique is useful because it is very simple and easy for making the clip with the ringthread without using adhesive agents. Authors declare no conflict of interests for this article.