A prospective randomized trial comparing the pocket-creation method and conventional method of colorectal endoscopic submucosal dissection

Abstract Background and Aims Colorectal endoscopic submucosal dissection (ESD) is recognized as a challenging procedure. Previously, we reported that a new ESD strategy using the pocket-creation method (PCM) is useful for colorectal ESD, but there has been no prospective randomized study to evaluate the efficacy of the PCM. The aim of this study was to evaluate the efficacy and safety of PCM for colorectal ESD compared with the conventional method (CM). Methods This was a prospective randomized controlled trial at 3 institutions in Japan. Patients with superficial colorectal neoplastic lesions >20 mm predicted to be intramucosal were randomly assigned to undergo ESD using the PCM or CM. Primary outcome was the ESD completion rate defined as completion of colorectal ESD with an en bloc resection using the assigned ESD method without changing to other methods or assisted by other devices. Results We analyzed 59 patients with 59 colorectal tumors in the PCM group and 55 in the CM group. ESD completion rate was significantly higher in the PCM group compared with the CM group (93% [55/59] vs 73 % [40/55]; P = 0.01). En bloc resection rates, R0 resection rates, procedure time and dissection speed were not significantly different comparing the 2 groups. The incidence of adverse events was similar in the 2 groups. Conclusions Use of the PCM allows the endoscopist to complete the procedure with the intended method more often than the CM with similar clinical outcomes.