LAUSR

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 tractionassisted 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). 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 clipring 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). 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 con▶ Fig. 1 The elastic traction device.