CC BY-NC-ND 4.0 · Endosc Int Open 2017; 05(12): E1299-E1305
DOI: 10.1055/s-0043-118744
Original article
Eigentümer und Copyright ©Georg Thieme Verlag KG 2017

Clinical effectiveness of the pocket-creation method for colorectal endoscopic submucosal dissection

Akira Kanamori1, Masakazu Nakano1, Masayuki Kondo1, Takanao Tanaka1, Keiichiro Abe1, Tsunehiro Suzuki1, Hitoshi Kino1, Yoshihito Kaneko1, Chieko Tsuchida1, Kouhei Tsuchida1, Naoto Yoshitake1, Keiichi Tominaga1, Yasuo Imai2, Hideyuki Hiraishi1
  • 1Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
  • 2Department of Diagnostic Pathology, Dokkyo Medical University, Tochigi, Japan
Further Information

Publication History

submitted 10 May 2017

accepterd after revision 14 July 2017

Publication Date:
06 December 2017 (online)

Abstract

Background and study aims Endoscopic submucosal dissection (ESD) is a technically advanced procedure for colorectal tumors. Hayashi et al. invented the “pocket-creation method (PCM),” and reported that Is-type lesions with fibrosis could be efficaciously and safely resected. However, only case studies have been published, and there are no previous reports on the usefulness of PCM in colorectal ESD for all lesions, as compared with the conventional method. This study aimed to evaluate the effectiveness and safety of PCM in colorectal ESD.

Patients and methods Ninety-six colorectal tumors were treated: 47 using the PCM and the other 49, considered the control group, using the conventional method. Therapeutic effectiveness and safety were retrospectively assessed.

Results The comparison between the PCM and control groups revealed higher rates of en bloc resection (100 % vs. 88 %, P = 0.015) and curative endoscopic resection (100 % vs. 84 %, P = 0.0030) with PCM. There was no significant difference in perforation as an adverse event (AE) between the two groups, though perforation was observed in only 6 % of the control group and none of the PCM group. Compared with the control group, the PCM group had lower incidences of perforation and post-ESD coagulation syndrome, and both AEs were associated with excessive thermal denaturation of the muscle layer (2 % vs. 16 %, P = 0.018).

Conclusions This study demonstrated the effectiveness and safety of ESD with PCM for colorectal tumors. Although there is a possible learning curve, PCM enables the endoscopist to safely perform ESD in most cases without encountering the difficulties associated with conventional ESD.