Effectiveness and safety of endoscopic submucosal dissection using the pocket creation method in the Japanese population: a systematic review and meta-analysis

Abstract

Background and study aims Endoscopic submucosal dissection (ESD) is a standard method for minimally invasive resection of superficial gastrointestinal tumors. The pocket creation method (PCM) facilitates ESD regardless of location in the gastrointestinal tract. The aim of this systematic review and meta-analysis is to evaluate the effectiveness and safety of ESD for superficial neoplasms in the upper and lower gastrointestinal tract comparing the PCM to the non-PCM. Methods Randomized controlled, prospective, and retrospective studies comparing the PCM with the non-PCM were included. Outcomes included en bloc resection, R0 resection, dissection speed, delayed bleeding and perforation. Pooled odds ratios (ORs) with 95 % confidence intervals (CIs) using the Mantel-Haenszel random effect model were documented. Results Eight studies including gastric, duodenal, and colorectal ESD were included. The en bloc resection rate was significantly higher in the PCM group than the non-PCM group (OR 3.87, 95 %CI 1.24–12.10 P = 0.020). The R0 resection rate was significantly higher in the PCM group than the non-PCM group (OR 2.46, 95 %CI 1.14–5.30, P = 0.020). The dissection speed was significantly faster in the PCM group than the non-PCM group (mean difference 3.13, 95 % CI 1.35–4.91, P < 0.001). The rate of delayed bleeding was similar in the two groups (OR 1.13, 95 %CI 0.60–2.15, P = 0.700). The rate of perforation was significantly lower in the PCM group than the non-PCM group (OR 0.34, 95 %CI 0.15–0.76, P = 0.009). Conclusions The PCM facilitates high-quality, fast and safe colorectal ESD. Further studies are needed regarding the utility of PCM in ESD of the upper gastrointestinal tract.

Endoscopic submucosal dissection techniques and technology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review

“…The PCM method was compared with conventional ESD in a meta-analysis, in which PCM showed significantly higher R0 and en bloc resection rates (93.5 % vs. 78.1 %, and 99.8 % vs. 92.8 %, respectively), along with shorter procedure time and faster dissection speed (mean difference –11.5 minutes, and 3.6 mm 2 /min, respectively), and a lower overall adverse event rate (4.4 % vs. 6.6 %) 21 . Two more recent meta-analyses also support the benefits of PCM 22 23 .…”

Predictive factors associated with technical difficulty in colorectal endoscopic submucosal dissection: A Honam Association for the Study of Intestinal Disease (HASID) multicenter study

“…Performance of colorectal ESD has been gradually improved along as new endoscopic instruments have been developed and novel ESD techniques such as traction-assisted ESD and pocket creation methods have been proposed. [10,11] However, colorectal ESD is still technically difficult with a steep learning curve compared to gastric ESD. [3] And so, it is important to assess the difficulty before the procedure to improve the treatment outcome of colorectal ESD.…”

“…Pre-procedural baseline characteristics of enrolled patients and lesions are summarized in Table 1. The median age was 66.1 (IQR 57.7-73.8) years, median tumor size was 20.1 (15-29) mm on long axis and 16.5 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) mm on short axis. 662 (45.8%) were LST-G, 438 (30.3%) were LST-NG and 346 (23.9%) were protruded-type.…”

Electrosurgical knife with the water‐jet function of tip‐type during endoscopic treatment injection

“…Therefore, the pocket creation method or the tunneling method,as the minimal mucosal incision, might reduce the loss of injection agents. [12][13][14] Under such procedures, the injection performance of each knife might be improved.…”

“…Additionally, an excessive mucosal incision should be avoided in the actual endoscopic procedures to prevent the outflow of the injected agents. Therefore, the pocket creation method or the tunneling method, as the minimal mucosal incision, might reduce the loss of injection agents 12–14 . Under such procedures, the injection performance of each knife might be improved.…”