Usefulness of the S–O clip for gastric endoscopic submucosal dissection (with video)



Endoscopic submucosal dissection (ESD) is technically one of the most complicated endoscopic procedures. Traction methods have been reported to be effective for ESD. A recent study revealed that the S–O clip allowed faster and safer colonic ESD. We assessed the efficacy and safety of gastric ESD with the S–O clip for gastric epithelial neoplasm.


We performed a retrospective cohort study of patients treated for gastric ESD using the S–O clip between September and November 2016 (SO group, n = 48). The subjects were matched with patients treated with conventional gastric ESD from September 2015 to August 2016 (control group, n = 258) at Sendai Kousei Hospital, a tertiary endoscopic center. The primary outcome was procedure time. Multivariate logistic regression and propensity score matching analyses were performed to reduce the effects of selection bias for potential confounding factors differences like age, sex, lesion location, lesion position, presence of ulcer scarring, resected specimen size, and operator experiences.


Forty-eight pairs were created after propensity score matching. The mean procedure time (including the S–O clip attachment time) was significantly shorter in the SO group (47.2 ± 24.6 vs. 69.2 ± 67.1 min, p = 0.035). The mean clip attachment time was 4.4 (range 2–15) min. There were no significant differences in other treatment outcomes (en-bloc resection rate: 100 vs. 100%, p = 1.000; perforation rate: 0 vs. 2.1%, p = 0.315; delayed bleeding rate: 2.1 vs. 4.3%, p = 0.558).


The S–O clip improved the speed of gastric ESD by approximately 25%, without increasing adverse events.

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Correspondence to Rintaro Hashimoto.

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Drs Rintaro Hashimoto, Dai Hirasawa, Tomoyuki Iwaki, Hajime Yamaoka, Kousuke Nihei, Ippei Tanaka, Akimichi Chonan, and Kei Takase have no conflicts of interest or financial ties to disclose.

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Hashimoto, R., Hirasawa, D., Iwaki, T. et al. Usefulness of the S–O clip for gastric endoscopic submucosal dissection (with video). Surg Endosc 32, 908–914 (2018) doi:10.1007/s00464-017-5765-9

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  • Endoscopic submucosal dissection
  • Propensity score
  • Early gastric cancer
  • Traction method
  • S–O clip