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CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(07): E1062-E1069
DOI: 10.1055/a-1403-1153
Original article

The pocket-creation method facilitates endoscopic submucosal dissection of gastric neoplasms involving the pyloric ring

Masafumi Kitamura
1   Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
,
Yoshimasa Miura
1   Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
,
Satoshi Shinozaki
1   Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
2   Shinozaki Medical Clinic, Utsunomiya, Japan
,
Hirotsugu Sakamoto
1   Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
,
Yoshikazu Hayashi
1   Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
,
Mio Sakaguchi
3   Department of Diagnostic Pathology, Jichi Medical University, Shimotsuke, Japan
,
Noriyoshi Fukushima
3   Department of Diagnostic Pathology, Jichi Medical University, Shimotsuke, Japan
,
Alan Kawarai Lefor
4   Department of Surgery, Jichi Medical University, Shimotsuke, Japan
,
Hironori Yamamoto
1   Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
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Abstract

Background and study aims Endoscopic submucosal dissection (ESD) of superficial gastric lesions involving the pyloric ring is difficult. The pocket-creation method (PCM) with a small-caliber-tip transparent hood can overcome this difficulty by compressing the pyloric sphincter applying both traction and counter-traction. The aim of this study is to clarify the usefulness of the PCM for ESD of superficial gastric neoplasms involving the pyloric ring compared to the conventional method (CM).

Patients and methods From October 2006 to August 2019, 66 gastric lesions requiring duodenal submucosal dissection beyond the pyloric ring in 66 patients were resected. The CM was mainly performed in the first period (CM group, n = 46) and the PCM in the second period (PCM group, n = 20). We retrospectively reviewed their medical records.

Results Although no significant differences were observed in en bloc resection rates between the two groups, the PCM group had a significantly higher R0 resection rate than the CM group (P = 0.047). There were no holes in resected specimens in the PCM group while three specimens in the CM group had a hole. The dissection speed in the PCM group tended to be higher than in the CM group, although it did not reach statistical significance (P = 0.148). No significant differences were observed for the incidence of adverse events.

Conclusions This is the first study reporting the advantages of the PCM over the CM for ESD of gastric lesions involving the pyloric ring. We believe that the PCM is an effective strategy to compress the pyloric sphincter and facilitates R0 resection.



Publication History

Received: 08 October 2020

Accepted: 03 February 2021

Article published online:
17 June 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Ferlay J, Colombet M, Soerjomataram I. et al. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. Int J Cancer 2019; 144: 1941-1953
    CrossrefPubMedGoogle Scholar
  • 2 Konuma H, Matsumoto K, Ueyama H. et al. Procedure time for gastric endoscopic submucosal dissection according to location, considering both mucosal circumferential incision and submucosal dissection. Gastroenterol Res Pract 2016; DOI: 10.1155/2016/9183793.
    CrossrefPubMedGoogle Scholar
  • 3 Abe S, Wu SYS, Ego M. et al. Efficacy of current traction techniques for endoscopic submucosal dissection. Gut Liver 2020; 14: 673-684
    CrossrefPubMedGoogle Scholar
  • 4 Miura Y, Shinozaki S, Hayashi Y. et al. Duodenal endoscopic submucosal dissection is feasible using the pocket-creation method. Endoscopy 2017; 49: 8-14
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Hayashi Y, Sunada K, Takahashi H. et al. Pocket-creation method of endoscopic submucosal dissection to achieve en bloc resection of giant colorectal subpedunculated neoplastic lesions. Endoscopy 2014; 46 (Suppl. 01) E421-422
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Hayashi Y, Shinozaki S, Sunada K. et al. Efficacy and safety of endoscopic submucosal dissection for superficial colorectal tumors more than 50 mm in diameter. Gastrointest Endosc 2016; 83: 602-607
    CrossrefPubMedGoogle Scholar
  • 7 Takezawa T, Hayashi Y, Shinozaki S. et al. The pocket-creation method facilitates colonic endoscopic submucosal dissection (with video). Gastrointest Endosc 2019; 89: 1045-1053
    CrossrefPubMedGoogle Scholar
  • 8 Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer 2020; DOI: 10.1007/s10120-020-01042-y.
    CrossrefPubMedGoogle Scholar
  • 9 Hatta W, Gotoda T, Oyama T. et al. A Scoring system to stratify curability after endoscopic submucosal dissection for early gastric cancer: “eCura system”. Am J Gastroenterol 2017; 112: 874-881
    CrossrefPubMedGoogle Scholar
  • 10 Bae JH, Kim GH, Lee BE. et al. Factors associated with the outcomes of endoscopic submucosal dissection in pyloric neoplasms. Gastrointest Endosc 2015; 81: 303-311
    CrossrefPubMedGoogle Scholar
  • 11 Lim CH, Park JM, Park CH. et al. Endoscopic submucosal dissection of gastric neoplasia involving the pyloric channel by retroflexion in the duodenum. Dig Dis Sci 2012; 57: 148-154
    CrossrefPubMedGoogle Scholar