AUTHOR=Kitamura Masafumi , Miura Yoshimasa , Shinozaki Satoshi , Lefor Alan Kawarai , Yamamoto Hironori 

TITLE=The Pocket-Creation Method Facilitates Endoscopic Submucosal Dissection of Gastric Neoplasms Along the Lesser Curvature at the Gastric Angle

JOURNAL=Frontiers in Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.825325

DOI=10.3389/fmed.2022.825325

ISSN=2296-858X

ABSTRACT=Background: Endoscopic submucosal dissection (ESD) of superficial gastric lesions located along the lesser curvature at the gastric angle is a challenging situations due to paradoxical movement and a protruding angle. The pocket-creation method (PCM) can overcome this difficulty by stabilizing the tip of the endoscope in the pocket and minimizing insufflation of the stomach, which enables horizontal and straight dissection. The aim of this study is to clarify the usefulness of the PCM for ESD of superficial gastric neoplasms along the lesser curvature at the angle compared to the conventional method (CM). 
Methods: From October 2006 to June 2021, 158 gastric lesions along the lesser curvature at the angle were resected with needle-type knives. We retrospectively reviewed the records and divided them into the PCM group (n = 61) and the CM group (n = 97). The primary outcome measurement was dissection speed (in mm2/min).
Results: There were no statistically significant differences between the two groups in baseline characteristics such as macroscopic type and size except for the presence of adenomas. The proportion of expert endoscopists was not significantly different between the two groups. The dissection speed was significantly faster in the PCM group than in the CM group (P = 0.001). There were no holes in the resected specimens in the PCM group, while five lesions in the CM group (5%) had a hole. There were no significant differences in the incidence of adverse events. 
Conclusions: This is the first study reporting the advantages of the PCM over the CM for ESD of lesions located along the lesser curvature at the gastric angle. The PCM facilitated ESD of these lesions by significantly increasing dissection speed with no increase in the incidence of adverse events.