The pocket-creation method facilitates colonic endoscopic submucosal dissection (with video).

Area of Science:

• Gastroenterology
• Endoscopic Surgery

Background:

• Colonic endoscopic submucosal dissection (ESD) presents challenges due to endoscope maneuverability issues.
• Physiologic factors like flexion, peristalsis, and respiration complicate colonic ESD compared to rectal ESD.

Purpose of the Study:

• To evaluate the efficacy of the pocket-creation method (PCM) for colonic ESD.
• To compare PCM with the conventional method (CM) for colonic ESD, irrespective of lesion characteristics.

Main Methods:

• A retrospective chart review of 543 colonic lesions treated with ESD.
• Lesions were divided into two groups: PCM (n=280) and CM (n=263).
• Primary outcome was en bloc resection rate; secondary outcomes included R0 resection, adverse events, dissection time, and speed.

Main Results:

• The PCM group demonstrated significantly higher en bloc resection rates (100% vs 96%) and R0 resection rates (91% vs 85%) compared to the CM group.
• Dissection speed was significantly faster in the PCM group (23.5 mm²/min vs 20.9 mm²/min).
• Dissection time and incidence of adverse events (perforation, delayed bleeding) were similar between groups.

Conclusions:

• Colonic ESD utilizing the PCM method significantly enhances en bloc and R0 resection rates.
• The PCM technique facilitates faster dissection during colonic ESD.
• PCM offers an improved approach to colonic ESD with comparable safety to conventional methods.