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. 2021 May;35(5):2110-2118.
doi: 10.1007/s00464-020-07614-4. Epub 2020 May 7.

Clinical utility of the pocket-creation method with a traction device for colorectal endoscopic submucosal dissection

Daisuke Ide  1   2 , Tomohiko Richard Ohya  3 , Shoichi Saito  4 , Yuki Mitsuyoshi  4   5 , Hiroyuki Hatamori  4 , Yohei Ikenoyama  4 , Keigo Suzuki  4 , Mitsuaki Ishioka  4 , Seichi Yakabi  4 , Chihiro Yasue  4 , Akiko Chino  4 , Masahiro Igarashi  4 , Masayuki Saruta  5 , Junko Fujisaki  4
Affiliations

Clinical utility of the pocket-creation method with a traction device for colorectal endoscopic submucosal dissection

Daisuke Ide et al. Surg Endosc. 2021 May.

Abstract

Background: Colorectal endoscopic submucosal dissection (ESD) is technically demanding while ensuring safety, especially in cases with fibrosis and/or poor maneuverability. To overcome such difficulties, we developed a novel method called the pocket-creation method with a traction device (PCM with TD). We then evaluated the effectiveness and safety of PCM with TD in colorectal ESD compared to other conventional methods.

Methods: In total, 324 colorectal lesions treated with ESD from July 2018 to June 2019 were included. The following three treatment strategies were used: conventional ESD (CE), CE with TD, and PCM with TD. Patient backgrounds and treatment outcomes were retrospectively compared and analyzed.

Results: As ESD methods, CE, CE with TD, and PCM with TD account for 58% (187/324), 24% (78/324), and 18% (59/324), respectively. No significant difference was observed among the three groups in en bloc and R0 resection rates or adverse events. The rate of lesions with fibrosis and poor maneuverability was significantly higher in the PCM with TD group (CE group vs CE with TD group vs PCM with TD group: fibrosis, 24% vs 47% vs 64%, p < 0.001; poor maneuverability, 5.3% vs 13% vs 20%, p = 0.002). Dissection speed was significantly higher in the PCM with TD than in the CE with TD group (p = 0.003).

Conclusions: PCM with TD can achieve a stable en bloc resection rate and R0 dissection rate without adverse events even in the hands of trainees, irrespective of the size and location of the lesion, presence of fibrosis, and under poor maneuverability conditions.

Keywords: Colorectal tumor; Endoscopic submucosal dissection; Pocket-creation method; Traction device.

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