Thread-Traction with a Sheath of Polypectomy Snare Facilitates Endoscopic Submucosal Dissection of Early Gastric Cancers

Figure 3

After circumferential mucosal incision, the clip with the thread covered by the sheath is attached to the edge of the lesion, including both the mucosal and submucosal layers (a). The thread-traction methods using a sheath of polypectomy snare (TTSPS) allow independent movement of the thread and the endoscope, and traction force can be easily controlled without interfering with the movement of the endoscope (a and b). The lesion can be pulled not only towards the oral side (c) but also towards the anal side by positioning the sheath over the anal side of the lesion (d). In the TTSPS method, countertraction can be easily applied to the anal side of the tumor, and the submucosal layer of the tumor is clearly visible when the tumor is located in the antrum (c and d).

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