ASGE JGES Advanced ESD (On-Demand) | September 2022 OLESDSEPT22ADV-Yamamoto PCM

Yamamoto PCM_2022

Pdf Summary

This document discusses the concept and technical tips for utilizing the pocket-creation method (PCM) in endoscopic submucosal dissection (ESD) for the treatment of cancer. ESD is a procedure used for the resection of early gastrointestinal (GI) cancer. The benefits of ESD include reliable en bloc resection, low risk of local recurrence, and high quality specimen for examination. The PCM involves creating a large submucosal pocket using a small-caliber-tip transparent hood. The key advantages of PCM include stable control of the endoscope tip, easy recognition of blood vessels, selection of dissection plane, and prevention of bleeding. The pocket-creation method is performed using a specially designed hood and sodium hyaluronate injection. The technique involves visualizing the submucosal tissue during the dissection and widening the pocket to complete the submucosal dissection. The advantages of PCM include good traction, prevention of leakage, lessening of respiratory movement, and adjustment of approach angle. Tips for performing PCM include injection into the appropriate layer, initial submucosal dissection, diving into the submucosal layer with the hood, window-blind appearance in the rectum, recognition of the muscle layer, and measuring the depth of the pocket. Overall, PCM offers a reliable and effective approach to ESD for the treatment of early GI cancer.

Keywords

pocket-creation method

endoscopic submucosal dissection

cancer treatment

gastrointestinal cancer

en bloc resection

local recurrence

high quality specimen

transparent hood

bleeding prevention

submucosal tissue visualization