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BACKGROUND: Endoscopic submucosal dissection (ESD) allows en bloc resection of large GI neoplasms, regardless of their size; however, technical difficulties associated with ESD in the colorectum make it less widely applied in the treatment of tumors in this region. To address this difficulty, we designed a rubber strip-based traction device, called the S-O clip (Sakamoto-Osada clip) and reported previously that ESD with this device was effective for complete resection of large, superficial colorectal neoplasms. In this report, we describe a novel spring-action version of the S-O clip (spring S-O clip) that improves the facility of clip use during ESD of colorectal tumors. OBJECTIVE: To evaluate the efficacy and safety of the spring S-O clip for ESD of colorectal neoplasms. DESIGN: Case series. SETTING: Juntendo University Hospital. MAIN OUTCOME MEASUREMENTS: The efficacy and safety of the spring S-O clip traction device during ESD of colorectal tumors. RESULTS: In 3 cases, a large, superficial neoplasm in the right side of the colon was removed safely and successfully en bloc without complication. Procedure times for the 3 cases were 44, 27, and 49 minutes, with resected specimens measuring 40, 24, and 35 mm, respectively. LIMITATION: Uncontrolled study. CONCLUSION: This limited case series demonstrates that spring S-O clip-assisted ESD is safe and effective for en bloc resection of large superficial neoplasms in the right side of the colon. [ABSTRACT FROM AUTHOR]

To assess the risk of variceal bleeding, endoscopic findings in 172 patients with esophageal varices were classified based on the "General Rules for Recording Endoscopic Findings on Esophageal Varices" prepared by the Japanese Research Society for Portal Hypertension. Among the factor which enabled an accurate prediction of bleeding were the red wale marking and cherry-red spot of the red color sign category and blue varices of the fundamental color category with large varices. Other factors in the "General Rules" such as the form and location were of minor significance in prediction of the bleeding. Each of these factors can be quantified and an assessment can be made of the likelihood of bleeding. By calculating the total score of these factors, the risk of bleeding in individual patients was accurately estimated.