Freehand Suturing to Apply Traction During Endoscopic Submucosal Dissection

The technique of freehand suturing in gastrointestinal endoscopy has evolved through technical developments such as knotless barbed wire sutures and needle manipulators, with initial publications showing promising results [1] [2]. The main advantage of freehand suturing over currently used device-based suturing is the ease of the technique. The method of freehand suturing offers a variety of possible applications, but these are not yet well established. Besides closing of mucosal or complete wall defects of the gastrointestinal tract, one of our first thoughts was the use of the suture string to apply tension to the mucosa while performing resections such as endoscopic submucosal dissection (ESD) or submucosal tunnel preparation. We present the technique of freehand suture traction during ESD in a porcine stomach.