Clip-assisted distal traction enables efficient en bloc snare excision of a small rectal neuroendocrine tumor

A 40-year-old woman underwent screening colonoscopy, which revealed a small rectal subepithelial lesion. The nodule was firm and sessile, without ulceration or central depression. Endoscopic ultrasonography showed a well-circumscribed, homogeneous hypoechoic lesion confined to the second to third echo layers, consistent with origin from the muscularis mucosae and/or submucosa. Given the typical features of a rectal neuroendocrine tumor (NET 1) and the small size (≤10 mm), endoscopic en bloc resection was planned to achieve histologically complete (R0) excision while minimizing the risk of muscularis propria injury. Postoperative histopathology confirmed a grade 1 NET. To facilitate efficient and safe removal, we performed a clip-assisted traction-snare resection (Video 1). Before insertion, a snare (JHY-SD-23-230-15-A1, Jiuhong Instrument Co. , Ltd, China) with a loop diameter of 15 mm was advanced through the working channel and used to secure the clip delivery catheter to the endoscope shaft, providing stable, controlled deployment (Fig. 1 a). After reaching the lesion, a metal clip (SD-T-2421-15, Kangjin Instrument Co. , Ltd, China) with an opening diameter of 15 mm was applied to the nodule apex and used to apply sustained distal (anal-side) traction, tenting the lesion away from the muscularis propria and improving delineation of the resection plane (Fig. 1 b). The snare was then positioned at the base to capture the entire lesion (Fig. 1 c), enabling controlled en bloc resection with intact specimen retrieval (Fig. 1 d). No immediate bleeding, deep mural injury, or perforation occurred, and the patient recovered uneventfully. This technique combines clip-assisted distal traction with snare resection to improve lesion elevation and reduce the likelihood of muscularis propria involvement. By creating a stable traction vector from the lesion apex, it may shorten the procedure time while increasing the probability of en bloc, R0 excision for small rectal subepithelial lesions suspected to be NETs. EndoscopyUCTNCodeCCL₁AD₂AC EndoscopyUCTNCodeTTT₁AQ₂AD₃AB Article published online: 17 February 2026 © 2026. The Author (s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https: //creativecommons. org/licenses/by/4. 0/). Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany