ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) is a minimally invasive procedure for the treatment of large tumors. It was reported that the method of traction assisted ESD made colorectal ESD easier and safer. There are various methods for making a traction. The method of using a clip with ring-thread is cost-efficient, in addition, we can use the prepared various sizes of the ring-threads for various situations. The easiest method of attaching the ringthread to the clip is passing one side of the ring-thread through the crossing part of the clip arm (Video S1); however, sometimes the ring-thread drops off from the clip. When this happens, we have to pick up the ring-thread by the clip which can be cumbersome. We modified the method of attaching the ring-thread to the clip (Video S1). First, the whole ring-thread was passed through the crossing part of the clip arm (Video S1 and Fig. 1A). Then, we caught one end of the ring-thread and passed it over the other side of the loop across the base of the clip arm (Video S1 and Fig. 1B). Finally, we passed it thought the original ring-thread and tied it to the clip (Video S1 and Fig. 1C,D). In this case, we could obtain the traction distally and opening of the resection area by lifting the mucosa (Video S1). We used a standard clip (HX-610-90; Olympus, Tokyo, Japan) and 10-mm-diameter ring-thread of 5-0 nylon. We can also use other threads, such as silk or dental floss. This modified technique is useful because it is very simple and easy for making the clip with the ringthread without using adhesive agents. Authors declare no conflict of interests for this article.

中文翻译：

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大肠内镜黏膜下剥离术牵引用环形线夹的改良制作方法

内镜黏膜下剥离术 (ESD) 是一种用于治疗大肿瘤的微创手术。据报道，牵引辅助ESD的方法使结直肠ESD更容易、更安全。有多种制造牵引力的方法。使用带环螺纹的夹子的方法经济实惠，此外，我们可以根据各种情况使用准备好的各种尺寸的环螺纹。将环线连接到夹子上的最简单方法是将环线的一侧穿过夹臂的交叉部分（视频 S1）；然而，有时环线会从夹子上脱落。发生这种情况时，我们必须通过夹子拿起环线，这可能很麻烦。我们修改了将环线连接到剪辑的方法（视频 S1）。第一的，整个环线穿过夹臂的交叉部分（视频 S1 和图 1A）。然后，我们抓住环线的一端并将其越过夹臂底部的环的另一侧（视频 S1 和图 1B）。最后，我们通过它认为原始的环线并将其绑在剪辑上（视频 S1 和图 1C、D）。在这种情况下，我们可以通过提升黏膜来获得远端牵引和切除区域的开口（视频 S1）。我们使用了标准夹子（HX-610-90；Olympus，Tokyo，Japan）和 10 毫米直径的 5-0 尼龙环线。我们也可以使用其他线，例如丝绸或牙线。这种改进的技术很有用，因为它非常简单且容易制作带有环形线的夹子，而无需使用粘合剂。作者声明本文不存在利益冲突。