Comparison of the pocket-creation method with the conventional method of endoscopic submucosal dissection for cecal and ascending colon lesion resection.

Abstract

Objective: To compare the pocket-creation method (PCM) with the conventional method of endoscopic submucosal dissection (ESD) for cecal and ascending colon lesion resection.

Methods: The data of patients who underwent ESD for cecal or ascending colon lesions were retrospectively analyzed. The patients were divided into the PCM group and the conventional group according to the method of ESD. Baseline data, endoscopic characteristics, dissection speed, pathological results and adverse events were compared between the two groups. Dissection speed was also analyzed.

Results: Overall, 122 patients were included. The dissection speed in the PCM group was higher than in the conventional group (0.20 [0.11, 0.32] cm²/min vs. 0.12 [0.08, 0.20] cm²/min, Z = -2.813, p = 0.005). The proportion of patients with injury to the muscularis propria layer in the PCM group was lower than in the conventional group, though the difference was not significant (19.4% vs. 29.1%, χ² = 1.215, p = 0.270). The univariate analysis showed that low body mass index (BMI), use of the PCM, long lesion diameter, large lesion area, and minimal fibrosis were independent risk factors for fast dissection (all p < 0.05). The logistic regression analysis showed that high dissection speed was associated with the choice to use the PCM, longer lesion diameter, and no fibrosis.

Conclusion: For cecal and ascending colon lesions, the PCM is a better choice than the conventional method, especially in patients with fibrosis, and large lesion area.