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is a recently developed technique, but it is not widely used to treat the colorectum because of its degree of technical difficul− ty. It is possible that traction of the lesion may facilitate correct visualization of the lesion and make it easier to dissect. Sever− al techniques involving lesion traction have been reported [1 ±4]. However, these methods have not been widely em− ployed to date due to difficulty in both le− sion fit and ease of use. We therefore de− signed a new traction device, the “S−O clip (Sakamoto−Osada clip)”, for ESD. The S−O clip consists of a metallic clip at− tached by a nylon line to the edge of a plastic sheath, which is coated with a rubber strip (10 mm long and 1.5 mm wide) and connected to a double nylon loop at the other end (l" Fig. 1). The S−O clip can be passed through the instru− ment channel of the endoscope (l" Fig. 2). After partially dissecting the submucosa of the tumor, the S−O clip con− nects to the edge of the exfoliated mucosa (l" Fig. 3 a) and the colonic wall opposite the lesion. This results in pulling the le− sion up and opening the resection margin (l" Fig. 3 b). After the dissection, the ny− lon loop is cut using the loop cutter (l" Fig. 3 c). There is no need to withdraw the endoscope during the procedure de− scribed. Finally, the specimen is brought out using the forceps. ESD using the S−O clip has been per− formed on five superficial colorectal le− sions. En bloc resection was achieved in all five cases without complication. The mean size of the resected lesions was 27.4 mm (range 22 ±42 mm), and the pro− cedure time was 75.4 minutes (range 38± 110 minutes). We confirm that fitting the lesion with the S−O clip was easy and took only a few minutes (mean 2.5 minutes), and that the device facilitated both cor− rect visualization and easier dissection of the tumor. These preliminary results suggest that S−O clip−assisted ESD is effective, straightforward, and safe for the com− plete removal of large superficial colorec− tal neoplasms at any site of the colon (l" Fig. 4).

The facilitation of a new traction device (S-O clip) assisting endoscopic submucosal dissection for superficial colorectal neoplasms