ASGE JGES Advanced ESD | September 2022-Yamamoto PCM

Yamamoto PCM_2022

Pdf Summary

The Pocket-Creation Method (PCM) is a new strategy for endoscopic submucosal dissection (ESD) of colorectal laterally spreading tumors (LST). The key feature of PCM is the creation of a large submucosal pocket using a small-caliber-tip transparent hood. This method offers several advantages, including stable control of the endoscope tip, easy recognition of blood vessels, selection of the dissection plane, and prevention of bleeding. PCM is performed using a new ST hood and sodium hyaluronate injection, and it involves visualizing the submucosal tissue during the dissection to ensure a good vertical margin. The technique is different from tunneling ESD, as completion of the tunnel is not necessary. Instead, the focus is on widening the submucosal pocket to complete the submucosal dissection. PCM offers four advantages: good traction by stretching the submucosal tissue, preventing leakage of injected solution, lessening respiratory movement by synchronizing with the pocket, and adjusting the approach angle to the muscle layer. Tips for performing PCM include injecting into the appropriate layer, starting the initial submucosal dissection, diving into the submucosal layer with the tip of the ST hood, injecting above the muscle layer, and recognizing the muscle layer by changing the direction. Measurements of the depth of the pocket can be achieved through color change and guidelines for opening the pocket include additional injection before mucosal incision and hooking the submucosal tissue from inside towards the mucosal incision. Overall, PCM is a promising method for ESD of colorectal LST with several technical advantages.

Keywords

Pocket-Creation Method

PCM

endoscopic submucosal dissection

ESD

colorectal laterally spreading tumors

LST

submucosal pocket

transparent hood

sodium hyaluronate injection

tunneling ESD