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Systematic ReviewSystematic Review
Open Access

Pocket-creation method versus conventional method of endoscopic submucosal dissection for early gastric cancer

A systematic review and meta-analysis

Min-Min Song, Feng-Bing Wang, Jian-Lin Yang, Hai-Yan Zhang and Tai-Ping Wang
Saudi Medical Journal May 2025, 46 (5) 450-458; DOI: https://doi.org/10.15537/smj.2025.46.5.20250045
Min-Min Song
From the Department of Gastroenterology (Song, Yang, Zhang, T. Wang), The People’s Hospital Of Rizhao, and from the Department of Gastrointestinal Surgery (F. Wang), Rizhao Hospital of Traditional Chinese Medicine, Rizhao, China.
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  • For correspondence: [email protected]
Feng-Bing Wang
From the Department of Gastroenterology (Song, Yang, Zhang, T. Wang), The People’s Hospital Of Rizhao, and from the Department of Gastrointestinal Surgery (F. Wang), Rizhao Hospital of Traditional Chinese Medicine, Rizhao, China.
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Jian-Lin Yang
From the Department of Gastroenterology (Song, Yang, Zhang, T. Wang), The People’s Hospital Of Rizhao, and from the Department of Gastrointestinal Surgery (F. Wang), Rizhao Hospital of Traditional Chinese Medicine, Rizhao, China.
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Hai-Yan Zhang
From the Department of Gastroenterology (Song, Yang, Zhang, T. Wang), The People’s Hospital Of Rizhao, and from the Department of Gastrointestinal Surgery (F. Wang), Rizhao Hospital of Traditional Chinese Medicine, Rizhao, China.
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Tai-Ping Wang
From the Department of Gastroenterology (Song, Yang, Zhang, T. Wang), The People’s Hospital Of Rizhao, and from the Department of Gastrointestinal Surgery (F. Wang), Rizhao Hospital of Traditional Chinese Medicine, Rizhao, China.
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Article Figures & Data

Figures

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  • Figure 1
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    Figure 1

    - The Cochrane risk of bias assessment tool was used to evaluate the included articles’quality. A) Risk of bias graph; B) risk of bias summary.

  • Figure 2
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    Figure 2

    - Flow diagram of study selection.

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    Figure 3

    - Forest plots comparing PCM-ESD to CM-ESD. A) Forest plot of the R0 resection rate; B) forest plot of the en bloc resection.

  • Figure 4
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    Figure 4

    - Forest plots comparing PCM-ESD to CM-ESD. A) Forest plot of dissection speed; B) forest plot of procedure time.

  • Figure 5
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    Figure 5

    - Forest plots comparing PCM-ESD to CM-ESD. A) Forest plot of delayed bleeding; B) forest plot of perforation.

Tables

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    Table 1

    - Characteristics of the included studies.

    AuthorsStudy periodsCountriesTypes of studySettingsPCM/CM
    Gender (male:female)Age, mean±SD (years)No. of patients
    Wu et al142022-2023ChinaRCTsingle center22:6/17:1065.5(55.3-70.8)/61(57-72)28/27
    Lin et al152019-2021ChinaRetrospectivesingle center23:9/25:764 (55.3-74.25)/66 (56.5-71)32/32
    Lee et al162018-2021KoreaRetrospectivesingle center32:16/37:1566.63±12.48/64.52±10.9548/52
    Kitamura et al172006-2021JapanRetrospectivesingle center48:13/72:1573 (51-93)/73 (53-89)61/97
    Kitamura et al182006-2019JapanRetrospectivesingle center13:7/29:1773 (70-79)/76 (68-79)20/46
    Harada et al192017-2017JapanRetrospectivesingle center42:6/44:475.6±6.8/75.2±7.148/48
    Liao et al202017-2018ChinaRCTsingle centerNA/NA41-82/39-8421/18

    PCM: pocket-creation method, CM: creation method, RCT: randomized controlled trial, NA: not available, SD: standard deviation

      • View popup
      Table 1

      - Characteristics of the included studies (continuation).

      AuthorsLesion size, median (mm)Presence of ulcerLocation (U/M/L)Location (G/L/A/P)Macroscopic type (0-I/0-II/0-III)
      PCMCMPCMCMPCMCMPCMCMPCMCM
      Wu et al1432 (27-40)30(25-40)327/10/117/10/105/13/6/45/14/5/31/27/03/24/0
      Lin et al1538 (35-40)34.5 (30-37)3210/12/1011/9/1212/10/2/811/8/5/82/30/02/30/0
      Lee et al16NANANANA12/8/287/12/3320/14/3/116/21/7/187/41/04/48/0
      Kitamura et al1721 (5-84)20 (4-70)12190/61/00/97/00/61/0/00/97/0/027/34(0-II or 0-III)58/39(0-II or 0-III)
      Kitamura et al1823 (13-35)20 (13-35)200/0/200/0/462/10/5/34/22/11/95/15(0-II or 0-III)22/24(0-II or 0-III)
      Harada et al1915 (10.8-20)15.5 (9.8-22.3)12117/18/239/14/2510/19/5/147/26/3/1223(0-I or 0-II)/2526(0-I or 0-II)/22
      Liao et al2027.9±23.732.2±18.2NANANANANANANANA

      PCM: pocket-creation method, CM: creation method, NA: not available, U: upper third, M: middle third, L: lower third, G: grater curvature, L: lesser curvature, A: anterior wall, P: posterior wall

        • View popup
        Table 2

        - Outcomes of clinical observation indicators in the included studies.

        AuthorsR0 resectionBloc resectionProcedure time (min)Dissection speed (mm2/min)PerforationDelayed bleeding
        PCMCMPCMCMPCMCMPCMCMPCMCMPCMCM
        Wu et al1427/2825/2728/2827/2730±7.1340±16.2721.5±1.3414.3±1.800/282/271/281/28
        Lin et al1531/3230/3232/3231/3238.5±4.1144.5±4.2919.6±0.7915±0.890/322/321/323/32
        Lee et al1642/4846/5248/4852/5273.46±40.8463.77±29.25NANA0/481/520/483/52
        Kitamura et al1755/6188/9761/6196/9765±53.0469±45.4220±9.2714±10.250/612/976/614/97
        Kitamura et al1820/2038/4620/2045/4675±14.1875±14.6916±3.4711±2.710/200/462/202/46
        Harada et al1947/4846/4848/4848/4827.5±5.8341±8.7922.5±4.1517.3±2.100/480/484/483/48
        Liao et al20NANANANA72.26±4.2599.73±12.57NANA0/212/180/214/18

        PCM: pocket-creation method, CM: creation method, NA: not available

          • View popup
          Table 3

          - Quality evaluation of the included articles using the Newcastle-Ottawa scale.

          AuthorsTypes of studyResearch object selection (0-4)Intergroup comparability (0-2)Outcome indicators (0-3)Total (0-9)
          Lin et al16Retrospective*******7
          Lee et al17Retrospective*******7
          Kitamura et al18Retrospective*******7
          Kitamura et al19Retrospective*******7
          Harada et al20Retrospective*******7

          One star for each point, maximum of 9 stars.

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          Saudi Medical Journal: 46 (5)
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          Vol. 46, Issue 5
          1 May 2025
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          Pocket-creation method versus conventional method of endoscopic submucosal dissection for early gastric cancer
          Min-Min Song, Feng-Bing Wang, Jian-Lin Yang, Hai-Yan Zhang, Tai-Ping Wang
          Saudi Medical Journal May 2025, 46 (5) 450-458; DOI: 10.15537/smj.2025.46.5.20250045

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          Pocket-creation method versus conventional method of endoscopic submucosal dissection for early gastric cancer
          Min-Min Song, Feng-Bing Wang, Jian-Lin Yang, Hai-Yan Zhang, Tai-Ping Wang
          Saudi Medical Journal May 2025, 46 (5) 450-458; DOI: 10.15537/smj.2025.46.5.20250045
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          Keywords

          • gastric cancers
          • gastric neoplasms
          • endoscopic submucosal dissection
          • ESD
          • pocket-creation method

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