Efficacy of the pocket-creation method with a traction device in endoscopic submucosal dissection for residual or recurrent colorectal lesions

• Published in: Clinical endoscopy 2022-09, Vol.55 (5), p.655-664
• Main Authors: Daisuke Ide, Tomohiko Richard Ohya, Mitsuaki Ishioka, Yuri Enomoto, Eisuke Nakao, Yuki Mitsuyoshi, Junki Tokura, Keigo Suzuki, Seiichi Yakabi, Chihiro Yasue, Akiko Chino, Masahiro Igarashi, Akio Nakashima, Masayuki Saruta, Shoichi Saito, Junko Fujisaki
• Format: Article
• Language: Korean
• Subjects: Colorectum; Endoscopic submucosal dissection; Pocket-creation method; Residual or recurrent lesion; Traction device
• ISSN: 2234-2400; 2234-2443

Background/Aims: Endoscopic submucosal dissection (ESD) for residual or recurrent colorectal lesions after incomplete resection is challenging because of severe fibrosis. This study aimed to compare the efficacy of the pocket-creation method (PCM) with a traction device (TD) with that of conventional ESD for residual or recurrent colorectal lesions. Methods: We retrospectively studied 72 patients with residual or recurrent colorectal lesions resected using ESD. Overall, 31 and 41 lesions were resected using PCM with TD and conventional ESD methods, respectively. We compared patient background and treatment outcomes between the PCM with TD and conventional ESD groups, respectively. The primary endpoints were en bloc resection and R0 resection rates. The secondary endpoints were the dissection speed and incidence of adverse events. Results: En bloc resection was feasible in all cases with PCM with TD, but failed in 22% of cases of conventional ESD. The R0 resection rates for PCM with TD and conventional ESD were 97% and 66%, respectively. Dissection was significantly faster in the PCM with TD group (13.0 vs. 7.9 mm2/min). Perforation and postoperative bleeding were observed in one patient in each group. Conclusions: PCM with TD is an effective method for treating residual or recurrent colorectal lesions after incomplete resection.