Use of a traction device facilitates opening of the pocket during the pocket-creation method of gastric endoscopic submucosal dissection

The pocket-creation method (PCM) is a strategy to achieve safe and high quality endoscopic submucosal dissection (ESD) throughout the alimentary tract [1] [2] [3] [4]. While the pocket is being created, the PCM enables endoscopists to effectively apply traction and countertraction using the tip of the hood alone. In this phase, the PCM can be considered a traction method; however, because stabilization of the endoscope tip and traction force gradually reduces while the pocket is being opened, it may become difficult and time-consuming. Particularly during gastric ESD, it is difficult to change the patient’s position and, as a result, it may not be possible to use gravity effectively, depending on the location of the lesion. We devised a new strategy for the PCM using traction devices when opening the pocket during gastric ESD ([Fig. 1]), as we have reported in the past for colorectal ESD [5].