Page 16 - Read Online

Hayashi et al. Mini-invasive Surg 2022;6:7 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2021.125

Technical Note Open Access

The pocket-creation method of endoscopic

submucosal dissection

1
2
1
Yoshikazu Hayashi , Yoshimasa Miura , Alan Kawarai Lefor , Hironori Yamamoto 1
1
Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke 329-0498, Japan.
2
Department of Surgery, Jichi Medical University, Shimotsuke 329-0498, Japan.
Correspondence to: Prof. Hironori Yamamoto, Department of Medicine, Division of Gastroenterology, Jichi Medical University,
Shimotsuke 329-0498, Japan. E-mail: ireef@jichi.ac.jp
How to cite this article: Hayashi Y, Miura Y, Lefor AK, Yamamoto H. The pocket-creation method of endoscopic submucosal
dissection. Mini-invasive Surg 2022;6:7. https://dx.doi.org/10.20517/2574-1225.2021.125

Received: 30 Oct 2021 First Decision: 29 Dec 2021 Revised: 7 Jan 2021 Accepted: 13 Jan 2021 Published: 8 Feb 2022

Academic Editors: Giulio Belli, Shinji Tanaka Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun Chen

Abstract
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.

Keywords: Pocket-creation method, endoscopic submucosal dissection, ESD, colon, rectum, stomach, duodenum

INTRODUCTION
Endoscopic treatments have gradually been preferred over surgical resection because of their less
invasiveness and their ability to preserve the original organs. In general, endoscopic treatments are

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

www.misjournal.net