Self-Made Internal Traction Method For Endoscopic Submucosal Dissection of Early Gastric Cancer

This protocol describes a self-made multiring thread method to provide controlled internal traction during endoscopic submucosal dissection (ESD) for early gastric cancer. ESD is a minimally invasive treatment that enables en bloc resection; however, the procedure can be technically challenging when adequate visualization and access to the submucosal layer are limited. Conventional traction methods, such as the dental floss clip technique, may be hindered by interference with the endoscope and instability of clip attachment. To address these limitations, a multiring thread device was developed to enable stable and adjustable traction. The device allows precise control of traction direction and force without interfering with endoscope maneuverability. This protocol outlines the preparation and deployment of the multiring thread during the procedure. The method facilitates improved exposure of the submucosal layer, enhances procedural efficiency, and supports safe dissection. This approach provides a simple, cost-effective, and reproducible technique for improving outcomes in gastric ESD.