Endoscopic Submucosal Dissection (ESD) : adoption of pocket creation method in a tertiary Centre in Singapore

Aim :A retrospective review of a single centre's adoption of pocket creation method in colorectal ESD.Method :Patients' records from all colorectal ESD cases performed in our institution were selected from June 2014 to January 2016. A total of 55 colonic ESD cases were performed and nine cases were excluded as they were deem unsuitable on examination. Results : A total of 46 patients underwent colonic ESD in which the average age was 68.4(47-85). 22 cases were done via pocket creation method and 24 via hybrid/others. 12 out of 22 cases achieved complete en bloc resection whereas the remaining 10 cases required endoscopic piecemeal resection(EPMR). The complication rate of the pocket creation method was 4.6% (1/22) versus the hybrid group 8.3%(2/24). The size of the lesion resected in the pocket creation method ranged from 23-60mm x 20-55mm with the largest en bloc resection specimen at 60mm x 55mm x 7mm. Conclusion : Overall pocket creation method is safe, effective and facilitates submucosal dissection to achieve en bloc resection of colonic lesions. Safety and success rates can be improved via development of new strategies, training system and equipment.