Double nylon loop-based inner traction technique promoting endoscopic submucosal dissection of a giant pedunculated adenoma in the ascending colon

Endoscopic submucosal dissection (ESD) is feasible for the removal of giant pedunculated polyps with thick stalks when conventional snare resection is difficult [1] [2]. Although pretreatment of the stalks can prevent bleeding in thick-pedunculated polyps, some cases simultaneously comprising massive polyp heads often cause restricted operability and poor visibility, thereby increasing operative challenges [3] [4] [5]. Herein, we describe a novel inner traction technique to facilitate ESD of a large thick-pedunculated polyp by securely ligating and effectively pulling the stalk with double nylon loops ([Video 1]).