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. 2022 Jan 6;22:10. doi: 10.1186/s12876-021-02085-w

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© The Author(s) 2022

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

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Fig. 1 — ESD procedure using MLTD. a Multi-loop traction device (MLTD). b Snag the MLTD at the base of the clip, mount the clip in the rotatable clip device, and deliver into the stomach through the forceps port. c Deliver a clip with MLTD attached from the end of the endoscope, and attach to the proximal side of the lesion mucosa. d Using another clip, snag an MLTD ring, and apply countertraction by attaching the clip to the gastric wall contralateral to the lesion. e Optimal traction and visualization are obtained during submucosal dissection. f The lesion is completely resected. ESD, endoscopic submucosal dissection; MLTD, multi-loop traction device