Pocket-creation method improves efficacy of colorectal endoscopic submucosal dissection: a system review and meta-analysis

Abstract

The pocket-creation method (PCM) is a new strategy for endoscopic submucosal dissection (ESD). The aim of this system review is to evaluate the clinical efficacy and safety of PCM-ESD compared to conventional ESD (C-ESD) for colorectal neoplasm lesions. We performed literature search using MEDLINE, EMBASE and CENTRAL database from inception to 15 February 2020. Studies provided comparison between PCM-ESD and C-ESD for colorectal neoplasm lesions were included. En bloc resection rate, R0 resection rate, occurrence rate of adverse events and operation speed/time were extracted from included studies. Pooled risk difference with 95% confidence intervals (CIs) was calculated in meta-analysis. Three cohort studies and one randomized control trial (RCT) were included, which contained 432 colorectal lesions removed by PCM-ESD and 959 lesions resected by C-ESD. PCM-ESD achieved significantly higher en bloc/R0 resection rate than C-ESD in cohort studies with pooled risk differences of 0.05 (CI, 0.03–0.07, I 2 = 34%) and 0.14 (CI, 0.04–0.24, I 2 = 83%). However, comparison of en bloc/R0 resection rate between two surgery strategies could not be estimated in RCT. Pooled results in cohort studies and data from RCT revealed comparable occurrence rate of adverse events between PCM-ESD and C-ESD. Measurements and outcomes of operation time/speed varied between the included studies and no consistent conclusion could be achieved in this aspect. The results indicate that PCM-ESD is an effective and well-tolerated treatment for colorectal neoplasm lesions and may be a superior treatment to C-ESD in en bloc/R0 resection rate.

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 .…”

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

“…The PCM was developed and disseminated to conquer these difficult circumstances and provide a shortcut to learning ESD for beginner endoscopists. Past systematic reviews and meta-analyses regarding the PCM were limited to colorectal ESD 17 18 . This is the first quantitative review evaluating the effectiveness and safety of the PCM in both the upper and lower gastrointestinal tract.…”

“…tematic reviews and meta-analyses regarding the PCM were limited to colorectal ESD [17,18]. This is the first quantitative review evaluating the effectiveness and safety of the PCM in both the upper and lower gastrointestinal tract.…”

Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection

“…A meta-analysis revealed significantly higher en bloc and R0 resection rates with comparable adverse event rates associated with this technique. 43…”