Pocket-creation method versus conventional method of endoscopic submucosal dissection for superficial colorectal neoplasms: a meta-analysis

Pei, Qingshan; Qiao, Hui; Zhang, Mingyan; Wang, Guangchuan; Feng, Hua; Pan, Jianmei; Shi, Yumeng

doi:10.1016/j.gie.2021.01.007

Cited by 22 publications

(16 citation statements)

References 23 publications

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“…The PCM was developed and disseminated to conquer these difficult circumstances and provide a shortcut to learning ESD for beginner endoscopists. Past systematic reviews and meta-analyses regarding the PCM were limited to colorectal ESD 17 18 . This is the first quantitative review evaluating the effectiveness and safety of the PCM in both the upper and lower gastrointestinal tract.…”

Section: Discussionmentioning

confidence: 99%

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Effectiveness and safety of endoscopic submucosal dissection using the pocket creation method in the Japanese population: a systematic review and meta-analysis

et al. 2022

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Background and study aims Endoscopic submucosal dissection (ESD) is a standard method for minimally invasive resection of superficial gastrointestinal tumors. The pocket creation method (PCM) facilitates ESD regardless of location in the gastrointestinal tract. The aim of this systematic review and meta-analysis is to evaluate the effectiveness and safety of ESD for superficial neoplasms in the upper and lower gastrointestinal tract comparing the PCM to the non-PCM. Methods Randomized controlled, prospective, and retrospective studies comparing the PCM with the non-PCM were included. Outcomes included en bloc resection, R0 resection, dissection speed, delayed bleeding and perforation. Pooled odds ratios (ORs) with 95 % confidence intervals (CIs) using the Mantel-Haenszel random effect model were documented. Results Eight studies including gastric, duodenal, and colorectal ESD were included. The en bloc resection rate was significantly higher in the PCM group than the non-PCM group (OR 3.87, 95 %CI 1.24–12.10 P = 0.020). The R0 resection rate was significantly higher in the PCM group than the non-PCM group (OR 2.46, 95 %CI 1.14–5.30, P = 0.020). The dissection speed was significantly faster in the PCM group than the non-PCM group (mean difference 3.13, 95 % CI 1.35–4.91, P < 0.001). The rate of delayed bleeding was similar in the two groups (OR 1.13, 95 %CI 0.60–2.15, P = 0.700). The rate of perforation was significantly lower in the PCM group than the non-PCM group (OR 0.34, 95 %CI 0.15–0.76, P = 0.009). Conclusions The PCM facilitates high-quality, fast and safe colorectal ESD. Further studies are needed regarding the utility of PCM in ESD of the upper gastrointestinal tract.

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Section: Discussionmentioning

confidence: 99%

“…tematic reviews and meta-analyses regarding the PCM were limited to colorectal ESD [17,18]. This is the first quantitative review evaluating the effectiveness and safety of the PCM in both the upper and lower gastrointestinal tract.…”

Section: E697mentioning

confidence: 99%

Effectiveness and safety of endoscopic submucosal dissection using the pocket creation method in the Japanese population: a systematic review and meta-analysis

et al. 2022

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“…A novel method that combines the PCM and internal traction has been developed[ 52 , 53 ], and it can possibly accelerate the dissection speed. A meta-analysis including five studies (two randomized controlled trials and three retrospective studies) evaluated the efficacy and safety of PCM in comparison with the conventional method for superficial colorectal neoplasms[ 69 ]. PCM achieved a higher R0 resection rate (93.5% vs 78.1%; OR, 3.4; 95%: 1.3–8.9; I 2 = 58%), a higher en bloc resection rate (99.8% vs 92.8%; OR, 9.9; 95%CI: 2.7–36.2; I 2 = 0), a shorter procedure time (min) [mean difference (MD), -11.5; 95%CI: -19.9 to -3.1; I 2 = 72%], a faster dissection speed (mm 2 /min) (MD, 3.6; 95%CI: 2.8–4.5; I 2 = 0), and a lower overall adverse event rate (4.4% vs 6.6%; OR, 0.6; 95%CI: 0.3–1.0; I 2 = 0) than the conventional method.…”

Section: Traction Methods Associated With Lesion Sitementioning

confidence: 99%

Advances in traction methods for endoscopic submucosal dissection: What is the best traction method and traction direction?

Nagata¹

2022

WJG

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Endoscopic submucosal dissection (ESD) has been developed as a treatment for superficial gastrointestinal neoplasms, which can achieve en bloc resection regardless of the lesion size. However, ESD is technically difficult because endoscopists cannot bring their hand into the gastrointestinal tract, unlike surgeons in regular surgery. It is difficult to obtain sufficient tension in the dissection plane and a good field of vision. Therefore, ESD is associated with a long procedure time and a high risk of adverse events in comparison with endoscopic mucosal resection. Traction methods have been developed to provide sufficient tension for the dissection plane and a good field of vision during the ESD procedure. However, traction direction is limited in most traction methods, resulting in insufficient effect in some cases. Although traction direction is considered important, there have been few investigations of its effect. In the first half of this review, important traction methods are discussed, including traction direction. In second half, appropriate traction methods for each organ are considered. Other important considerations for traction method, such as ability to adjust traction strength, interference between traction device and endoscope, and the need for specialized devices are also discussed.

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“…En 73 realizaron DSE-TBS y en 53 DSE con técnica convencional. Mostraron una mayor tasa de resección en bloque (100% DSE-TBS vs. 92% DSE convencional, p = 0,03) y una velocidad de disección más rápida para el grupo de DSE-TBS (mediana de 9 [13][14][15][16][17][18][19][20][21][22][23][24] vs. 14 [10][11][12][13][14][15][16][17][18][19][20][21][22]] mm 2 / min, p = 0,03). 12 Yamashina y colaboradores realizaron una revisión retrospectiva de 90 grandes tumores colorrectales sésiles en 89 pacientes sometidos a la DSE.…”

Section: A a B B C C D D E E F Funclassified

“…14 Recientemente, Pei Q y colaboradores publicaron un metaanálisis con un total de 1481 pacientes, demostrando que la DSE-TBS logra una tasa de resección R0 más alta (93,5% vs. 78,1%; odds ratio [OR] 3,4; intervalo de confianza [IC] 95% [1,[3][4][5][6][7][8]9]; I2 = 58%), una mayor tasa de resección en bloque (99,8% vs. 92,8%; OR 9,9; IC 95% [2,7-36,2]; I 2 = 0), con un menor tiempo de procedimiento, una velocidad de disección más rápida y una tasa global de eventos adversos más baja (4,4% vs 6,6%; OR 0,6; IC 95% [0,3-1,0]; I 2 = 0), en comparación con la DSE convencional. 15 Por lo tanto, la evidencia disponible señala que la DSE-TBS permite mejorar la calidad de la DSE al aumentar la tasa de resección en bloque, mejorar la velocidad de disección (sin aumentar la incidencia de los efectos adversos) y facilitar la superación de las dificultades asociadas.…”

Section: A a B B C C D D E E F Funclassified

Disección endoscópica con técnica de bolsillo submucoso. ¿Puede reemplazar a la disección convencional?

Yantorno¹,

Correa²,

Esteves³

et al. 2021

Acta gastroenterol. latinoam.

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Endoscopic submucosal dissection is a complex technique that allows en bloc resection of large lesions. It is associated with long-term, technically complex procedures and a high risk of complications. The creation of a submucosal pocket is a variant of the conventional technique that reduces these difficulties, generating a high rate of complete resection with a shorter procedure time, a faster dissection speed and a lower rate of adverse events. Even though this variant was initially described in the stomach, its application has been generalized to other areas of the digestive tract. We present two cases where this variant technique was applied to treat large early lesions, with technical success.

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Pocket-creation method versus conventional method of endoscopic submucosal dissection for superficial colorectal neoplasms: a meta-analysis

Cited by 22 publications

References 23 publications

Effectiveness and safety of endoscopic submucosal dissection using the pocket creation method in the Japanese population: a systematic review and meta-analysis

Effectiveness and safety of endoscopic submucosal dissection using the pocket creation method in the Japanese population: a systematic review and meta-analysis

Advances in traction methods for endoscopic submucosal dissection: What is the best traction method and traction direction?

Disección endoscópica con técnica de bolsillo submucoso. ¿Puede reemplazar a la disección convencional?

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