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Efficacy and safety of pocket-creation method for early gastric cancers

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Abstract

Background

Endoscopic submucosal dissection (ESD) is the standard endoscopic treatment for early gastric cancers (EGCs). However, obscured view and difficulty in submucosal lifting during ESD have been demonstrated. Additionally, ESD is time-consuming and poses a high risk of perforation and bleeding when performed in challenging locations. The pocket-creation method (PCM) is a newly developed strategy for colorectal tumors, while the outcomes of application in the treatment of EGCs are rarely reported. In the present study, we aimed to compare the technical efficacy and safety of PCM-ESD and the conventional ESD (c-ESD) technique for the treatment of EGCs.

Methods

This was a single-center retrospective study consisting of 162 patients with EGCs who underwent ESD between February 2019 and February 2021. One-to-one propensity score matching (PSM) was performed. In addition, clinicopathological characteristics and treatment outcomes were also compared.

Results

PCM-ESD was more likely to be used in patients with larger lesions than c-ESD with/without traction. In addition, the resection speed for lesions of the PCM-ESD was faster compared with c-ESD without traction (median dissection speed: 19.6 mm2/min vs. 15 mm2/min; p < 0.001) and c-ESD with traction (median dissection speed after PSM: 19.9 mm2/min vs. 15 mm2/min; p = 0.001). In multiple linear regression analysis, significant factors related to a higher dissection speed were the treatment method of PCM-ESD (p = 0.034), the long diameter of the resected lesion (p = 0.001), and lesion location (p = 0.046).

Conclusions

Collectively, PCM-ESD appeared to be a safer and more effective treatment for EGCs than c-ESD. In addition, PCM-ESD could significantly improve the speed of tumor resection.

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Acknowledgements

Thank members of the Department of Gastroenterology of the the Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University.

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Author notes

  1. Min Lin and Jiajia Wu contributed equally to this work.

Authors and Affiliations

  1. Department of Gastroenterology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, 213000, China

    Min Lin, Jiajia Wu & Shaohua Zhuang

  2. Department of General Surgery, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, 68 Gehu Middle Road, Wujin District, Changzhou, 213000, Jiangsu, China

    Haojun Yang & Xihu Qin

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  1. Min Lin
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  2. Jiajia Wu
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  3. Shaohua Zhuang
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Correspondence to Xihu Qin.

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Min Lin, Jiajia Wu, Shaohua Zhuang, Haojun Yang and Xihu Qin have no conflicts of interest or financial ties to disclose.

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Supplementary file1 (MP4 28319 KB) Video 1. Procedure for endoscopic submucosal dissection of gastric neoplasms involving the gastric horn with the pocket-creation method

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Lin, M., Wu, J., Zhuang, S. et al. Efficacy and safety of pocket-creation method for early gastric cancers. Surg Endosc 37, 1581–1592 (2023). https://doi.org/10.1007/s00464-022-09620-0

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