Debates on colorectal endoscopic submucosal dissection - traction for effective dissection: gravity is enough.

Colorectal endoscopic submucosal dissection (ESD) still remains a technically difficult procedure. The maintenance of tissue tension and good submucosal exposure during dissection is one of the most important factors for an effective and safe dissection. Although various traction methods have been developed, traction by gravity is one of the most useful method for colorectal ESD. Traction using adjunctive devices can thus be reserved for extremely difficult cases or for endoscopists in their learning periods for colorectal ESD.