Is the Endoscopic Grasp-and-Traction Device Useful for Endoscopic Submucosal Dissection in Treating Early Gastric Cancer?

has become possible to achieve en bloc and histologically complete resection of gastric tumors with endoscopic submu-cosal dissection (ESD), regardless of size, allowing for the re-section of tumors that would not have been previously possible. 1,2 However, ESD is a challenging technique with a higher complication rate than that of endoscopic mucosal resection. The main difficulty of ESD is the dissection of the submuco-sal layer. Locating the optimal plane under direct visualization reduces the possibility of perforation and unexpected, massive bleeding and improves the chance of achieving complete resection, but this procedure is particularly challenging. There are several techniques for widening the endoscopic view during gastric ESD through counter-traction, which allows for safe and rapid dissection if performed well. These techniques can be divided into two groups according to whether a grasping point is stabilized. In the first group, a clip is used to create counter-traction accompanied by a sinker, 3 a string , 4 a magnetic anchor, 5 or a spring action SO clip. 6 In the second group, counter-traction is achieved by using grasping forceps which are detached/attached to the endoscope 7,8 or introduced from a double-channel endoscope, 9 a transanal/ anal thin endoscope, 10,11 or percutaneous trocar. 12 Oyama 13 presents various methods for creating a clear field of vision, such as changing position, a clip, external grasping forceps, internal traction, a double-channel scope, and a dual scope approach. Each of these has both advantages and disadvantages. While using a clip is simple, it can be difficult to control the counter-traction as direction is limited. Using a grasping forceps is a more flexible approach to create counter-traction, although handling the forceps can be challenging. was developed in order to simplify and enhance the safety profile of the submucosal dissection procedure. This traction device offers improved endoscopic view of the submucosal layer resulting in quick and safe dissection. While it does appear to be a promising tool only a single study has been published to date. 14 In this issue of Clinical Endoscopy, Schölvinck et al. 15 present their experience investigating the contributory value of the EndoLifter towards the performance of ESD by analyzing its effect on the speed of submucosal dissection. This ex vivo comparative study was conducted in an animal model and the group compared dissection speeds (procedural duration per unit area of submucosal dissection [min/cm 2 ]) both with and without the EndoLifter in each …