Pocket-creation method of endoscopic submucosal dissection to achieve en bloc resection of giant colorectal subpedunculated neoplastic lesions

Abstract

Endoscopic submucosal dissection (ESD) has become a standard minimally invasive therapy in Japan for large, superficial, colorectal neoplasms [1]. Although polypectomy or endoscopic mucosal resection is generally effective for polypoid lesions, ESD is an effective alternative to achieve en bloc resection in difficult cases, such as giant, subpedunculated, neoplastic lesions that are at least 3 cm in diameter [2]. However, ESD for giant, subpedunculated, neoplastic lesions is associated with technical difficulties because severe submucosal fibrosis occurs at the center of these lesions due to prolapse, resulting in the muscle layer being pulled upward.