Uploaded September 2025 | Updated September 2026, 3 days ago
Georgios Mavrogenis (1), MD, Stamatina Vogli (1), MD, Stavros Dimitriadis (1), MD, Haris Giannopoulos (1), MD, Loukas Kaklamanis (2), MD, Vasiliki Kyriakidou (2), MD, Fateh Bazerbachi (3), MD.
1. Department of Gastroenterology, Unit of Hybrid Interventional Endoscopy, Mediterraneo Hospital, Athens, Greece
2. Department of Pathology, Mediterraneo Hospital, Athens, Greece
3. CentraCare, Interventional Endoscopy Program, St. Cloud Hospital, St. Cloud, Minnesota, USA
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 gastro-esophageal 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.
Conclusion: 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.
Georgios Mavrogenis (1), MD, Stamatina Vogli (1), MD, Stavros Dimitriadis (1), MD, Haris Giannopoulos (1), MD, Loukas Kaklamanis (2), MD, Vasiliki Kyriakidou (2), MD, Fateh Bazerbachi (3), MD.
1. Department of Gastroenterology, Unit of Hybrid Interventional Endoscopy, Mediterraneo Hospital, Athens, Greece
2. Department of Pathology, Mediterraneo Hospital, Athens, Greece
3. CentraCare, Interventional Endoscopy Program, St. Cloud Hospital, St. Cloud, Minnesota, USA
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 gastro-esophageal 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.
Conclusion: 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.
