title: Effectiveness of clip-and-snare method using pre-looping technique for gastric endoscopic submucosal dissection.
abstract: OBJECTIVE
  To evaluate efficacy and safety of clip-and-snare method using pre-looping technique (CSM-PLT) for gastric endoscopic submucosal dissection (ESD).
  
  
  METHODS
  In the CSM-PLT method, a clip attached to the lesion side was strangulated with a snare, followed by application of an appropriate tension to the lesion independent of an endoscope. Twenty consecutive lesions were resected by ESD using CSM-PLT (CSM-PLT group) and compared with a control group, including 20 lesions that were resected by conventional ESD. The control group was matched based on the size and location of the lesion, presence of pathologic fibrosis, and experience of endoscopists. Total procedure time of ESD, proportion of en bloc resection, and complications were analyzed.
  
  
  RESULTS
  The total procedure time for the CSM-PLT group was significantly shorter than that for the control group (38.5 min vs 59.5 min, P = 0.023); all lesions were resected en bloc by ESD. There was no significant difference in complications between the two groups. Moreover, there was no complication in the CSM-PLT group. In one large lesion (size: 74 mm) that underwent extensive CSM-PLT during ESD, we used an additional CSM-PLT on another edge of the lesion after achieving submucosal resection to the maximum extent possible during initial CSM-PLT. In two lesions, the snare came off the lesion together with the clip after a sudden pull; nevertheless, ESD was successful in all lesions.
  
  
  CONCLUSIONS
  CSM-PLT was an effective and safe method for gastric ESD.
authors.affiliation: Naohiro Yoshida, Hisashi Doyama, Ryosuke Ota, Yasuhito Takeda, Hiroyoshi Nakanishi, Kei Tominaga, Shigetsugu Tsuji, Kenichi Takemura, Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa 920-8530, Japan.
authors.forename: Naohiro
authors.initials: N
authors.lastname: Yoshida
authors.affiliation: Naohiro Yoshida, Hisashi Doyama, Ryosuke Ota, Yasuhito Takeda, Hiroyoshi Nakanishi, Kei Tominaga, Shigetsugu Tsuji, Kenichi Takemura, Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa 920-8530, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Doyama
authors.affiliation: Naohiro Yoshida, Hisashi Doyama, Ryosuke Ota, Yasuhito Takeda, Hiroyoshi Nakanishi, Kei Tominaga, Shigetsugu Tsuji, Kenichi Takemura, Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa 920-8530, Japan.
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Ota
authors.affiliation: Naohiro Yoshida, Hisashi Doyama, Ryosuke Ota, Yasuhito Takeda, Hiroyoshi Nakanishi, Kei Tominaga, Shigetsugu Tsuji, Kenichi Takemura, Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa 920-8530, Japan.
authors.forename: Yasuhito
authors.initials: Y
authors.lastname: Takeda
authors.affiliation: Naohiro Yoshida, Hisashi Doyama, Ryosuke Ota, Yasuhito Takeda, Hiroyoshi Nakanishi, Kei Tominaga, Shigetsugu Tsuji, Kenichi Takemura, Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa 920-8530, Japan.
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Nakanishi
authors.affiliation: Naohiro Yoshida, Hisashi Doyama, Ryosuke Ota, Yasuhito Takeda, Hiroyoshi Nakanishi, Kei Tominaga, Shigetsugu Tsuji, Kenichi Takemura, Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa 920-8530, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Tominaga
authors.affiliation: Naohiro Yoshida, Hisashi Doyama, Ryosuke Ota, Yasuhito Takeda, Hiroyoshi Nakanishi, Kei Tominaga, Shigetsugu Tsuji, Kenichi Takemura, Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa 920-8530, Japan.
authors.forename: Shigetsugu
authors.initials: S
authors.lastname: Tsuji
authors.affiliation: Naohiro Yoshida, Hisashi Doyama, Ryosuke Ota, Yasuhito Takeda, Hiroyoshi Nakanishi, Kei Tominaga, Shigetsugu Tsuji, Kenichi Takemura, Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa 920-8530, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Takemura
keywords: Clip-and-snare method; Dissection; Endoscope; Endoscopic submucosal dissection; Pre-looping technique