The usefulness of combining the pocket-creation method with a traction device using a scissor-type knife for colorectal endoscopic submucosal dissection

Introduction Technical issues and long procedure time still remain a concern in colorectal endoscopic submucosal dissection (ESD). We examined the usefulness of combining the pocket-creation method (PCM) with a traction device (S-O clip; SO) using a scissor-type knife (Clutch Cutter 3.5 mm; CC) for decreasing ESD procedure time. Methods We retrospectively analyzed 95 ESD cases of PCM + SO + CC managed from August 2017 to April 2020 and 103 cases of PCM + CC treated from July 2016 to July 2017. We compared these two groups through propensity score matching. The main outcome was the analysis of the ESD procedure times under various conditions in each group. Results After matching, 52 cases in the PCM + SO + CC and PCM + CC groups were analyzed. The PCM + SO + CC group showed a significantly shorter ESD procedure time than the PCM + CC group (57.8 +/- 31.4 vs. 81.7 +/- 33.5 min, p < 0.01). Additionally, the ESD procedure time was significantly shorter in the PCM + SO + CC group than in the PCM + CC group: tumor size (tumor size < 40 mm: 45.6 +/- 15.8 vs. 72.7 +/- 22.9 min, p < 0.01; tumor size >= 40 mm: 83.1 +/- 40.1 vs. 111.8 +/- 45.3 min, p = 0.04), tumor location (right side: 64.7 +/- 33.3 vs. 81.0 +/- 29.7 min, p = 0.03; left side: 50.5 +/- 28.0 vs. 82.3 +/- 36.9 min, p < 0.01), tumor morphology (polypoid: 39.2 +/- 18.6 vs. 74.7 +/- 28.6 min, p < 0.01; nonpolypoid: 62.3 +/- 32.3 vs. 84.5 +/- 35.2 min, p < 0.01), endoscopist (expert: 67.3 +/- 41.2 vs. 91.9 +/- 40.2 min, p = 0.02; nonexpert: 50.4 +/- 18.3 vs. 73.6 +/- 24.9 min, p < 0.01), and fibrosis (severe fibrosis: 82.0 +/- 20.5 vs. 99.8 +/- 40.4 min, p = 0.169; non-severe fibrosis: 52.1 +/- 23.8 vs. 75.6 +/- 29.0 min, p < 0.01). Conclusions The combination of the PCM and SO using CC achieved a reduction in the colorectal ESD procedure time.