Clip with rubber band modification for dynamic traction in colonic endoscopic submucosal dissection.

A 63-year-old-woman was referred because of a 40-mm laterally-spreading tumor, nongranular type (LST-NG), Paris 0-Is + IIa, JNET type 2B, in the descending colon, with a tattoo beneath it, consistent with a residual lesion following a previous resection. Endoscopic submucosal dissection (ESD) was initiated with a partial mucosal incision ([Video 1]). Difficulty was experienced in exposing the submucosal layer, even with the pocket-creation method and an underwater strategy.