Fig. 3.

A typical case of ring-shaped thread counter traction in cecal LST-NG. A Various sized ring-shaped threads (8–20 mm) were prepared before ESD. B The ring-shaped thread was hooked and lifted up to the contralateral mucosa with a hemoclip by deflating air. C In proportion to the amount of insufflation of CO₂, adjusting the strength of counter traction with the ring-shaped thread was possible. D As submucosal dissection was continued and the traction force of the ring-shaped thread was decreased, a second ring-shaped thread was placed to obtain additional counter traction force