Usefulness of the Long Cap-Assisted Method for Securing Countertraction During Endoscopic Submucosal Dissection

Endoscopic submucosal dissection (ESD) is effective but technically challenging, often requiring traction devices that involve multiple clips and added time. The long cap-assisted method, using a transparent cap with an extended tip, offers a simple alternative. In 2 cases—a 65-year-old with early gastric cancer and an 81-year-old with a large colonic laterally spreading tumor—standard caps failed to provide sufficient countertraction. Switching to a long cylindrical cap (not tapered) improved submucosal visualization and facilitated dissection. To our knowledge, this is the first report to specifically describe the long cap's use in achieving countertraction during endoscopic submucosal dissection.