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Updated: Jun 23, 2026

The Pocket-Creation Procedure of Endoscopic Submucosal Dissection for Large Rectal Laterally Spreading Tumors
Published on: February 13, 2026
Endoscopic submucosal dissection of large colorectal tumors by using a novel spring-action S-O clip for traction
Naoto Sakamoto1, Taro Osada, Tomoyoshi Shibuya
1Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan. sakamoto@juntendo.ac.jp
Background:
Endoscopic submucosal dissection (ESD) allows en bloc resection of large GI neoplasms, regardless of their size; however, technical difficulties associated with ESD in the colorectum make it less widely applied in the treatment of tumors in this region. To address this difficulty, we designed a rubber strip-based traction device, called the S-O clip (Sakamoto-Osada clip) and reported previously that ESD with this device was effective for complete resection of large, superficial colorectal neoplasms. In this report, we describe a novel spring-action version of the S-O clip (spring S-O clip) that improves the facility of clip use during ESD of colorectal tumors.
Objective:
To evaluate the efficacy and safety of the spring S-O clip for ESD of colorectal neoplasms.
Design:
Case series.
Setting:
Juntendo University Hospital.
Main Outcome Measurements:
The efficacy and safety of the spring S-O clip traction device during ESD of colorectal tumors.
Results:
In 3 cases, a large, superficial neoplasm in the right side of the colon was removed safely and successfully en bloc without complication. Procedure times for the 3 cases were 44, 27, and 49 minutes, with resected specimens measuring 40, 24, and 35 mm, respectively.
Limitation:
Uncontrolled study.
Conclusion:
This limited case series demonstrates that spring S-O clip-assisted ESD is safe and effective for en bloc resection of large superficial neoplasms in the right side of the colon.
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