Endoscopic submucosal dissection of large colorectal tumors by using a novel spring-action S-O clip for traction (with video)

Background Endoscopic submucosal dissection (ESD) allows en bloc resection of large GI neoplasms, regardless of their size; however, technical difficulties associated with ESD in the colorectum make it less widely applied in the treatment of tumors in this region. To address this difficulty, we designed a rubber strip-based traction device, called the S-O clip (Sakamoto-Osada clip) and reported previously that ESD with this device was effective for complete resection of large, superficial colorectal neoplasms. In this report, we describe a novel spring-action version of the S-O clip (spring S-O clip) that improves the facility of clip use during ESD of colorectal tumors. Objective To evaluate the efficacy and safety of the spring S-O clip for ESD of colorectal neoplasms. Design Case series. Setting Juntendo University Hospital. Main Outcome Measurements The efficacy and safety of the spring S-O clip traction device during ESD of colorectal tumors. Results In 3 cases, a large, superficial neoplasm in the right side of the colon was removed safely and successfully en bloc without complication. Procedure times for the 3 cases were 44, 27, and 49 minutes, with resected specimens measuring 40, 24, and 35 mm, respectively. Limitation Uncontrolled study. Conclusion This limited case series demonstrates that spring S-O clip-assisted ESD is safe and effective for en bloc resection of large superficial neoplasms in the right side of the colon.