{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:39:58Z","timestamp":1791419998969,"version":"4.3.3"},"reference-count":9,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2018,12,12]],"date-time":"2018-12-12T00:00:00Z","timestamp":1544572800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["JGH Open"],"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:p>Recently, traction\u2010assisted endoscopic submucosal dissection (ESD) using a clip and thread was reported as useful for treating lesions in the esophagus, stomach, and colorectum in terms of shortening the duration of the procedures and reducing the risk of intraoperative perforation. However, no traction method using the thread and clip for duodenal ESD as described in this article has been reported to date. We report a case in which traction\u2010assisted ESD using dental floss and a clip was successfully performed on a huge superficial nonampullary duodenal epithelial tumor accompanied by severe fibrosis caused by preoperative biopsies. A 65\u2010year\u2010old woman had a 55\u2010mm flat\u2010elevated tumor in the second part of the duodenum. Severe fibrosis of the submucosal layer was expected due to repeated biopsies at the same site by the patient\u2019s previous endoscopist. We selected ESD for this lesion, and the initial incision was started from the side proximal to the lesion, but it was difficult to insert the scope under the submucosal layer directly beneath the biopsy scar. Therefore, traction with an endoclip and dental floss was performed to lift the lesion. Excellent traction allowed safe resection of the fibrotic part under accurate visual observation. Finally, the lesion was resected <jats:italic>en bloc<\/jats:italic> without adverse events. Traction\u2010assisted ESD using dental floss and a clip is likely to be an effective adjunctive technique for quick, safe, and successful resection of lesions in the duodenum on which it is difficult to perform ordinary ESD and that have a high probability of intraoperative perforation and massive bleeding.<\/jats:p>","DOI":"10.1002\/jgh3.12118","type":"journal-article","created":{"date-parts":[[2018,12,12]],"date-time":"2018-12-12T11:41:57Z","timestamp":1544614917000},"page":"179-181","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Successful traction\u2010assisted endoscopic submucosal dissection using dental floss and a clip for a huge superficial nonampullary duodenal epithelial tumor with severe fibrosis (with video)"],"prefix":"10.1002","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4515-5543","authenticated-orcid":false,"given":"Tomoaki","family":"Tashima","sequence":"first","affiliation":[{"name":"Department of Gastroenterology Saitama Medical University International Medical Center  Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kouichi","family":"Nonaka","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Saitama Medical University International Medical Center  Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroki","family":"Kurumi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Saitama Medical University International Medical Center  Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuko","family":"Fujii","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Saitama Medical University International Medical Center  Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2765-3306","authenticated-orcid":false,"given":"Yuki","family":"Tanisaka","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Saitama Medical University International Medical Center  Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shomei","family":"Ryozawa","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Saitama Medical University International Medical Center  Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,12,12]]},"reference":[{"key":"e_1_2_4_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2018.05.002"},{"key":"e_1_2_4_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/den.12396"},{"key":"e_1_2_4_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2017.11.031"},{"key":"e_1_2_4_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/den.13036"},{"key":"e_1_2_4_6_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0044-102255"},{"key":"e_1_2_4_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/den.12860"},{"key":"e_1_2_4_8_1","first-page":"1","article-title":"Efficacy of sufficient operation view by ring\u2010shaped thread counter traction for safer duodenal ESD","author":"Goda Y","year":"2018","journal-title":"Minim. Invasive Ther. Allied Technol."},{"key":"e_1_2_4_9_1","first-page":"262","article-title":"Endoscopic submucosal dissection for large superficial colorectal tumors using the \"clip\u2010flap method\"","volume":"47","author":"Yamamoto K","year":"2015","journal-title":"Endoscopy"},{"key":"e_1_2_4_10_1","first-page":"281","article-title":"Impact of the clip and snare method using the prelooping technique for colorectal endoscopic submucosal dissection","volume":"48","author":"Yamada S","year":"2016","journal-title":"Endoscopy"}],"container-title":["JGH Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fjgh3.12118","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jgh3.12118","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jgh3.12118","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jgh3.12118","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,10]],"date-time":"2023-09-10T08:30:49Z","timestamp":1694334649000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jgh3.12118"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,12,12]]},"references-count":9,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2019,4]]}},"alternative-id":["10.1002\/jgh3.12118"],"URL":"https:\/\/doi.org\/10.1002\/jgh3.12118","archive":["Portico"],"relation":{},"ISSN":["2397-9070","2397-9070"],"issn-type":[{"value":"2397-9070","type":"print"},{"value":"2397-9070","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,12,12]]},"assertion":[{"value":"2018-10-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-11-03","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-12-12","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}