Recent traction methods for endoscopic submucosal dissection

Table 1 Characteristics of each traction method

	Traction direction	Control of traction	Complexity of procedure	Required device
Clip with line method	Only pull	Possible	Simple	Requires no special device
External forceps method	Push and Pull	Possible	Simple	Requires no special device
Clip and snare methods using prelooping technique	Push and Pull	Possible	Simple	Requires no special device
Internal traction method	Any direction	Impossible	Complex	Requires special device
Double scope method	Any direction	Possible	Complex	Need for space and another endoscope

Table 2 Traction method based on the anatomical site

	Head and neck	Esophagus	Stomach	Colon and rectum
Clip with line method	No report, but theoretically possible	Very useful	Useful, especially in the greater curvature of gastric body	Modified method is useful in any colon
External forceps method	Useful	Useful	Difficult in the cardia and the lesser curvature of upper gastric body	Rectum only
Clip and snare methods using prelooping technique	No report, but theoretically possible	No report, but theoretically possible	Useful	Useful, but requires overtube in deep colon
Internal traction method	No report	No report	Difficult in the pylorus and the cardia	Useful
Double scope method	No report, but theoretically possible	No report	Useful	Rectum only