Pre-placement sharp angle traction-assisted endoscopic submucosal dissection for the treatment of laterally spreading tumors of the colon

Endoscopic submucosal dissection (ESD) is challenging in the colon due to limited submucosal space, as well as factors such as colonic folds and respiratory movements. Thus, traction-assisted endoscopy has gained attention 1; yet, the best traction technique remains under debate. The previously reported double-clip counter-traction method, while effective, faces limitations as the counter-traction effect diminishes and the submucosal space narrows during the procedure 2. In this study, we refined the double-clip counter-traction technique and introduced a preplacement sharp angle traction method (Video 1).