LAUSR

A 70-year-old woman was referred to our hospital for the treatment of a laterally spreading tumor in the ascending colon (▶Fig. 1). Endoscopic submucosal dissection (ESD) was performed using a novel strategy with an orthodontic elastic rubber band (Latex Elastics Light 8mm; Tomy International, Osaka, Japan) and EndoTrac (EndoTrac T type; Top, Tokyo, Japan) (▶Fig. 2, ▶Video 1) [1]. The latter is a traction device composed of a plastic sheath and a line with an adjustable loop at its tip. For preparation, the rubber band was tied to the tip of EndoTrac and wrapped around the endoscope hood twice. Both the endoscope and EndoTrac were inserted simultaneously. ESD was started from the partial mucosal incision at the anal side of the lesion, followed by deeper cutting. Then, the EndoTrac was released by pulling on the sheath while the endoscope was in the retroflexed position (▶Fig. 3 a). The rubber band was grasped by a rotatable clip, which could be reopened multiple times (SureClip mini; Micro-Tech, Nanjing, China). The clip was anchored to the mucosal incision site. Adjustment of traction was possible by pushing or pulling the sheath while changing the length of the string. Pushing the sheath to the oral side was useful for exposing the submucosal layer, resulting in easy creation of the mucosal flap (▶Fig. 3b). Once the flap was created, the circumferential incision was completed and submucosal dissection was started. Pulling the sheath to the anal side was helpful for mainVideo 1 The rubber band and sheath method for endoscopic submucosal dissection of proximal colonic lesions. ▶ Fig. 1 White-light view of the laterally spreading tumor in the ascending colon.