Anchor-pronged clip-assisted countertraction in submucosal tunneling endoscopic resection and endoscopic submucosal dissection: a novel technique for submucosal tumors.

Background and Aims: Clip-assisted countertraction techniques have not been applicable in the context of submucosal tunneling endoscopic resection (STER) and endoscopic submucosal dissection (ESD) of submucosal tumors, primarily because conventional clips are unable to secure firm submucosal tumors. Methods: We used a novel clip with anchor prongs for clip-and-line countertraction of a leiomyoma of the gastroesophageal junction removed by STER and for a stromal tumor of the angulus removed by ESD. This clip features angulated sharp edges designed to embed into tissue, offering a new potential application: facilitating countertraction during STER and ESD. Results: By applying clip-and-line traction, the endoscopist gained improved access to the distal portion of the tumor, thus enhancing exposure of the dissection plane and minimizing the risk of inadvertent injury to adjacent tissues. Additionally, at the conclusion of STER, the lesion secured by the attached thread was efficiently retrieved from the tunnel. In a similar fashion, clip-and-band traction facilitated the enucleation of a gastric submucosal tumor attached to the muscle layer. Conclusions: We introduce a novel technique of anchor-pronged clip-assisted countertraction specifically designed for the resection of submucosal tumors, applicable to both STER and ESD procedures.