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Updated: Jun 8, 2026
The Pocket-Creation Procedure of Endoscopic Submucosal Dissection for Large Rectal Laterally Spreading Tumors
Published on: February 13, 2026
Pocket-creation versus conventional method in endoscopic submucosal dissection of gastric body tumors: a randomized
Dae Hyun Lim1, In-Kyung Sung2, Sang Pyo Lee1
1Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea.
Background And Aims:
The pocket-creation method (PCM) has shown promising results for colorectal endoscopic submucosal dissection (ESD). However, its efficacy and safety for gastric neoplasms remain unclear. This study aimed to determine whether PCM is noninferior to the conventional method (CM) regarding postprocedural adverse event rates for gastric body tumors.
Methods:
This multicenter, prospective, randomized, noninferiority trial was conducted at 3 tertiary referral centers in South Korea between December 2021 and January 2024. A total of 140 patients with gastric body tumors meeting expanded indications for ESD were randomized to undergo resection with either PCM (group I, n = 70) or CM (group II, n = 70). The primary outcome was the incidence of post-ESD adverse events, including perforation, bleeding, and post-ESD electrocoagulation syndrome. The prespecified noninferiority margin was a risk difference of 15%. Secondary outcomes included en bloc/complete/curative resection rates, resection margin status, procedure time, need for subsequent surgery, and hospitalization duration.
Results:
The overall post-ESD adverse event rate was 14.3% (10 of 70) in the PCM group and 12.9% (9 of 70) in the CM group. The absolute risk difference was 1.4%. The 2-sided 95% CI for this difference was -12.77% to 9.92%. As the upper limit was below the 15% margin, the noninferiority of PCM was demonstrated. En bloc (98.6% vs 98.6%) and complete resection (92.9% vs 88.6%) rates were comparable. Notably, the incidence of subsequent surgical operation was significantly lower in the PCM group (2.9%) than in the CM group (12.9%) (P = .028). Mean procedure times were comparable between the 2 groups (56.8 minutes vs 59.7 minutes, P = .701).
Conclusions:
The PCM demonstrates noninferiority to the CM with respect to post-ESD adverse events and provides an effective, safe alternative for gastric body ESD.
