| Since it was first described by Yamamoto et al., the pocket-creation method (PCM) for endoscopic submucosal dissection (ESD) has become a well-established technique for safe resection of large, early neoplastic lesions of the gastrointestinal tract. At our institution in London, UK, we have combined it with our saline-immersion therapeutic endoscopy (SITE) method, since we find these complement each other. We find that SITE-PCM ESD: 1) almost eliminates any requirement for traction (since the buoyancy effect of the saline-immersion floats the lesion and this counteracts the force of gravity), 2) also enhances visualisation, through the elimination of smoke and debris/fat micelles float-away rather than stick to the lens or hood, 3) enhances patient comfort through avoidance of excessive gaseous distension. The use of saline itself is important, since we find that water reduces the efficacy of knife function. In this lecture we describe the technique and our experience to date. |
