The pocket-creation method of endoscopic submucosal dissection

Abstract

Endoscopic submucosal dissection (ESD) is rapidly becoming the standard treatment for superficial gastrointestinal tumors because ESD can achieve complete local resection facilitating thorough pathological examination of the resected specimen. The pocket-creation method (PCM) has been established to perform safe and reliable ESD obtaining a high-quality pathological specimen. A minimal mucosal incision using PCM minimizes leakage of submucosally injected solution, which results in prolonged mucosal elevation. A limited-space submucosal pocket created using PCM makes the endoscope tip stable. A conical cap, small-caliber-tip transparent (ST) hood is used when performing PCM. The submucosa can be cut along the ideal dissection line just above the muscularis with minimal thermal damage because the tip of the ST hood produces both traction and countertraction to stretch the submucosal tissue in the pocket. PCM is recommended as the standard strategy not only for colorectal ESD but also for upper-gastrointestinal ESD. It is expected that the use of traction techniques will make PCM easier to perform.

Multicenter prospective randomized controlled clinical trial comparing the pocket-creation method with and without single-clip traction of colonic endoscopic submucosal dissection

“…Unauthorized distribution is strictly prohibited. The PCM secures thick less-burned submucosa with resected specimens containing information regarding the risk of lymph node metastasis [27] [28]. PCM-CT and the PCM both achieved high R0 resection rates also in the present study (Table 2).…”

Trans‐anal Foley catheter facilitates endoscopic submucosal dissection of a distal rectal tumor

“…When performing rectal endoscopic submucosal dissection (ESD), collapsing of the lumen with frequent aspiration of gas can provide a thick submucosal tissue and provide stable endoscope maneuverability 1–3 . Recently, we introduced the placement of a trans‐anal nasogastric tube to allow gas and fluid to drain 4 .…”

Nasogastric-tube decompression facilitates the pocket-creation method of gastric endoscopic submucosal dissection.

“…Aspirating gas from the stomach and collapsing the lumen facilitates the PCM because it helps to keep the submucosa thick and improves the controllability of the endoscope ( Fig. 1 ) 3 . However, it is not efficient to aspirate gas while placing the electric knife in the accessory channel.…”