Multitraction with rubber bands and surgical silk as a method to facilitate endoscopic submucosal dissection.

We propose this variant of the clip technique as a method that assist traction during endoscopic submucosal dissection (ESD): traction on the mucosa plane using an hemoclip carrying a surgical silk and three rubber bands, before the incision, to allow easier access to the submucosa space. We propose this variant with the intention of facilitating access to ESD quickly and safely for beginners.

Endoscopic removal of an embedded uncovered biliary self-expandable metal stent with a mechanichal lithotriptor.

Biliary fully-covered self-expandable metal stents (FCSEMS) can be used for benign conditions since they can be removed. Uncovered SEMS (uSEMS) are employed for malignant biliary obstruction and are intended to be permanent. Furthermore, they are almost impossible to remove because they become embedded in the bile duct.