Traction methods for endoscopic submucosal dissection

Endoscopic submucosal dissection (ESD) is widely used to achieve en bloc resection of superficial neoplasms in the gastrointestinal tract.ESD is technically challenging because a "second hand" cannot be inserted to provide tissue tension and improve the visibility of the dissection plane.To overcome such difficulties and provide appropriate tension in the desired direction, various traction methods have been introduced, ranging from natural traction using gravity, buoyancy, and water pressure, to hood traction and device-assisted traction using special devices such as dental floss or clips inserted into the gastrointestinal tract.Using the traction method generally results in shorter ESD procedure time and a lower incidence of complications.Therefore, for difficult lesions, it may be helpful to utilize various traction techniques.