Climate change is a global issue. By changing our habits, we can tackle the climate
emergency and build a sustainable world. Every effort can contribute to modify the
future of our planet. In medicine, some disciplines have already integrated the concept
of environmental effects of unused pharmaceutical products [1]
[2]
[3]
[4]
. In the endoscopic field, the green change is not yet a daily practice.
We report a technique to remove traction using the knife during an endoscopic ubmucosal
dissection (ESD). Here we describe two patients who underwent ESD for a colonic and
a gastric superficial neoplasia, respectively ([Video 1]). A multi-traction technique was performed using a device of three intertwined loops.
Each loop was attached to an edge of the lesion, and the entire device was attached
to the opposite wall to facilitate the exposure of the submucosal area. Then an en
bloc ESD was done. To remove the traction, we used the same knife by grasping the
extremity of the clip with the point of the knife. The tumor was then removed gently
using the knife and cap aspiration to pull it out of the patient. Hemostasis of the
dissection plane was done using the same knife. Nevertheless, the use of the snare
to remove the traction is still useful if the knife were to be re-used for endoscopy
teaching because the knife would be damaged from removing the traction.
Video 1 To an ecological endoscopic submucosal dissection: tips and tricks to reduce waste.
Avoiding the snare to remove the traction is possible. Decreasing the use of the device
during an endoscopic procedure is feasible. This technique will not change the patient
tumor prognosis but will contribute to reduce waste and lessen our environmental impact.
Every act counts to help to preserve our planet.
Endoscopy_UCTN_Code_TTT_1AU_2AZ
Endoscopy E-Videos is an open access online section, reporting on interesting cases and new techniques
in gastroenterological endoscopy. All papers include a high quality video and all
contributions are freely accessible online. Processing charges apply (currently EUR
375), discounts and wavers acc. to HINARI are available.
This section has its own submissionwebsite athttps://mc.manuscriptcentral.com/e-videos
