A prospective randomized trial comparing the pocket-creation method and conventional method of endoscopic submucosal dissection in early gastric cancers and precancerous lesions

Jiajia Wu; Siyu Li; Li Fan; Yuqing Cheng; Jin Huang; Min Lin

doi:10.1016/j.gassur.2024.04.013

A prospective randomized trial comparing the pocket-creation method and conventional method of endoscopic submucosal dissection in early gastric cancers and precancerous lesions

J Gastrointest Surg. 2024 Apr 16:S1091-255X(24)00417-7. doi: 10.1016/j.gassur.2024.04.013. Online ahead of print.

Authors

Jiajia Wu¹, Siyu Li¹, Li Fan¹, Yuqing Cheng², Jin Huang¹, Min Lin³

Affiliations

¹ Department of Gastroenterology, the Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, 213000, China.
² Department of Pathology, the Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, 213000, China.
³ Department of Gastroenterology, the Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, 213000, China. Electronic address: tianya-liulang@sohu.com.

PMID: 38636721
DOI: 10.1016/j.gassur.2024.04.013

Abstract

Background: Endoscopic submucosal dissection (ESD) is widely used as a standard treatment regimen for early gastric cancers (EGCs). However, such an approach is time-consuming and has a high risk of perforation and bleeding in some corner-site lesions because of the obscured view and difficulty in submucosal lifting. The newly developed pocket-creation method (PCM) provides a clearer view and better traction of the submucosal layer than conventional ESD (c-ESD). Nevertheless, no prospective randomized study has evaluated the efficacy of the PCM in EGCs and precancerous lesions.

Methods: This was a prospective randomized controlled trial. Patients with superficial gastric neoplastic lesions≥20mm were randomly assigned to the PCM-ESD group or c-ESD group. The primary outcome was dissection speed.

Results: There were 28 patients in the PCM-ESD group and 27 in the c-ESD group. The median dissection speed was significantly higher in the PCM-ESD group than in the c-ESD group (21.5 mm²/min vs. 14.3 mm²/min, P<0.001). Meanwhile, the operation time in the PCM-ESD group was significantly shorter than that in the c-ESD group (30min vs. 40min，P=0.047). In multiple linear regression analysis, the treatment method was independently associated with the resection speed of ESD.

Conclusions: PCM-ESD was an effective and safe treatment for EGCs and precancerous lesions.

Keywords: early gastric cancers; endoscopic submucosal dissection; pocket-creation method.