Figure 3.

S-O clip-assisted gastric endoscopic submucosal dissection in the retroflexed position. A, After separation of the lesion from the peripheral mucosa, the movement of the endoscope axis during submucosal dissection in retroflexed position is confirmed. B, The S-O clip is attached on the anal side of the lesion in the direction that the nylon loop comes over the mucosa. C. It is easy to hook the nylon loop with an anchor clip because the nylon loop comes over the mucosa. D, The S-O clip is anchored on the opposite side of the lesion in the forward position. E, Good visualization of the submucosa and adequate traction are obtained with extension of the spring. F, Complete en bloc resection is achieved, and there is no damage to the specimen due to the S-O clip.