Endoscopic intermuscular dissection (EID) is a critical therapeutic approach for early gastrointestinal cancers and precancerous lesions 1. However, in cases involving large laterally spreading tumors (LSTs) in the distal rectum, two persistent challenges compromise surgical outcomes: inadequate intraoperative visualization due to limited surgical field exposure and optimal closure of extensive post-resection defects 2 3. While conventional dental floss-assisted traction offers procedural simplicity, it often fails to provide sufficient traction force during EID for large distal rectal LSTs, resulting in incomplete submucosal layer exposure 4. Meanwhile, the closure of large mucosal defects postendoscopic resection poses a significant challenge. Traditional methods, including the titanium clip and the over-the-scope clip, have limitations in terms of complexity and applicability to large defects 5. To address these limitations, we innovatively integrated orthodontic rubber band-assisted traction with the through-the-scope twin clip, performing a stepwise non-full-thickness super minimally invasive resection (SMIS). This combined technique not only enhanced submucosal muscular layer visualization but also enabled rapid and secure closure of large postresection defects. Characterized by operational simplicity and cost-effectiveness, this approach represents a novel solution for managing extensive LSTs in the distal rectum.
Lv et al. (Fri,) studied this question.