ENDOSCOPIC SUBMUCOSAL DISSECTION WITH THE POCKET-CREATION METHOD

Abstract

The pocket-creation method (PCM) was introduced to overcome technical issues of endoscopic submucosal dissection (ESD) of large subpedunculated tumors. This innovative technique provides several advantages. PCM facilitates the dissection of a thick submucosal layer with minimal mucosal incision, preventing ‘diffuse lift', and provides effective traction and counter-traction as the tip of the ST hood elongates the submucosal tissue and assists dissection. This technique enhances recognition of the muscularis layer and thus a deep dissection is feasible, ensuring a high-quality pathological specimen with an adequate margin. In challenging lesions located on a vertical wall or over a fold, the approach of the knife converts from vertical to tangential by insertion of the tip of the endoscope into the pocket. In addition, having the tip of the endoscope in the pocket provides stability, counteracting any movement due to breathing or heartbeat. In our experience, ESD with PCM is a well-established, useful and safe technique that appears to be an effective alternative to standard ESD.