SYSTEMATIC REVIEW article
Front. Med.
Sec. Gastroenterology
This article is part of the Research TopicReviews in Gastroenterology 2025View all 9 articles
The clinical efficacy of pocket creation method ESD and conventional ESD in the treatment of early colorectal neoplasms: A meta-analysis
Provisionally accepted
- Jilin University, Changchun, China
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Background: This study systematically evaluated the efficacy and safety of the pocket creation method endoscopic submucosal dissection (PCM-ESD) compared with conventional endoscopic submucosal dissection (C-ESD) in the treatment of early colorectal neoplasms. Results: Nine studies, including 2 randomized controlled trials and 7 retrospective cohort studies with a total of 1,899 patients, were included. PCM-ESD achieved higher en bloc resection rates (RR=1.05,95%CI:1.02~1.09, P=0.004) and complete (R0) resection rates (OR = 2.34, 95% CI: 1.62– 3.39, P <00001) than C-ESD. Superior outcomes were also observed in fibrotic lesions (OR 1.67; 95% CI 1.14–2.43; P = 0.008) and LST-NG-type polyps (OR 1.39; 95% CI 1.09–1.79; P = 0.009). No significant differences were found in non-curative resection rates (OR 0.83; 95% CI 0.52–1.30; P = 0.41). PCM-ESD demonstrated shorter procedure time(min) (MD −10.61; 95% CI −15.41 to −5.80; P < 0.0001) and faster dissection speed(mm2/min) (MD 4.56; 95% CI 3.19–5.92; P < 0.00001). Perforation rates were lower with PCM-ESD (OR 0.41; 95% CI 0.20–0.81; P = 0.01), while bleeding rates were comparable (OR 1.03; 95% CI 0.51–2.05; P = 0.94). Specimen size was larger in the PCM-ESD group (MD 2.83; 95% CI 0.66–5.00; P = 0.01). Postoperative pathology revealed no difference in submucosal invasion depth (OR 0.94; 95% CI 0.69–1.28; P = 0.69). Conclusions: In the treatment of early colorectal neoplasms, PCM-ESD was associated with higher en bloc and R0 resection rates, shorter procedure time, faster dissection speed, and a lower perforation rate compared with C-ESD. In contrast, no statistically significant differences were observed between the two techniques with respect to non-curative resection rates, pathological outcomes, or bleeding-related events. While several efficacy and safety-related indicators favored PCM-ESD, these findings should be interpreted with caution given the predominance of retrospective data and the heterogeneity of study designs. Overall, PCM-ESD appears to be a promising alternative technique, particularly for technically challenging lesions.
Keywords: Conventional ESD, Early colorectal neoplasms, Endoscopic Submucosal Dissection, Meta-analysis, pocket creation method
Received: 14 Oct 2025; Accepted: 19 Jan 2026.
Copyright: © 2026 结康, 张 and 陈. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: 更 陈
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