Open AccessThe pocket-creation method of endoscopic submucosal dissection
Author(s) -
Yoshikazu Hayashi,
Yoshimasa Mıura,
Alan Kawarai Lefor,
Hironori Yamamoto
Publication year - 2022
Publication title -
mini-invasive surgery
Language(s) - English
Resource type - Journals
ISSN - 2574-1225
DOI - 10.20517/2574-1225.2021.125
Subject(s) - endoscopic submucosal dissection , submucosa , endoscope , medicine , traction (geology) , endoscopic mucosal resection , surgery , dissection (medical) , resection , engineering , mechanical engineering
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.