Endoscopic submucosal dissection using endoclips to assist in mucosal flap formation (novel technique: “clip flap method”)

Abstract

Endoscopic submucosal dissection (ESD) requires a high skill level due to poor visualization and instability in the cutting area. Mucosal flap formation after beginning submucosal dissection is the most difficult part of the procedure but improves visibility in the cutting area and allows for easier dissection, because the mucosal flap can be lifted with an attachment fitted to the endoscope. Although traction systems for ESD were recently reported [1] [2] [3] [4] [5], these methods are complicated and not widely employed. We designed a simple "clip flap method" using the endoclip as a substitute for the mucosal flap until it is formed.