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Abstract

We thank Dr Despott et al1Despott E.J. Hirayama Y. Lazaridis N. et al.Saline immersion therapeutic endoscopy facilitated pocket-creation method for endoscopic submucosal dissection (with video).Gastrointest Endosc. 2019; 89: 652-653Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar for their interests in our recent publication, “Water-pocket endoscopic submucosal dissection for superficial gastric neoplasms.”2Harada H. Murakami D. Suehiro S. et al.Water-pocket endoscopic submucosal dissection for superficial gastric neoplasms (with video).Gastrointest Endosc. 2018; 88: 253-260Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar We agree with their descriptive term, “saline-pocket endoscopic submucosal dissection (SP-ESD).” As they pointed out, our procedure is fundamentally a pocket-creation method (PCM)3Hayashi Y. Miura Y. Yamamoto H. Pocket-creation method for the safe, reliable, and efficient endoscopic submucosal dissection of colorectal lateral spreading tumors.Dig Endosc. 2015; 27: 534-535Crossref PubMed Scopus (54) Google Scholar, 4Sakamoto H. Hayashi Y. Miura Y. et al.Pocket-creation method facilitates endoscopic submucosal dissection of colorectal laterally spreading tumors, non-granular type.Endosc Int Open. 2017; 5: E123-E129Crossref PubMed Google Scholar, 5Miura Y. Shinozaki S. Shah J. et al.Duodenal endoscopic submucosal dissection is feasible using the pocket-creation method.Endoscopy. 2017; 49: 8-14PubMed Google Scholar, 6Yoshida N. Naito Y. Yasuda R. et al.The efficacy of the pocket-creation method for cases with severe fibrosis in colorectal endoscopic submucosal dissection.Endosc Int Open. 2018; 6: E975-E983Crossref PubMed Google Scholar with saline solution. Water-pocket endoscopic submucosal dissection (WP-ESD) with the use of saline solution also has the disadvantages of impairing the endoscopic view because of the bubbles generated by diathermy. However, the bubbles may be attenuated by the use of other types of solutions. For example, in the urological field, a solution of mannitol and sorbitol has been tried in transurethral resections. The bubbles arise from an electrosurgical knife with electrocautery because of the steaming of the solution. Not only the boiling point but also the quantity of the bubbles is considered to be different according to the various types of the solution used. We are ready for the further study of WP-ESD with the use of different solutions, and a solution other than saline solution might be used in the future. Therefore, we tentatively named this procedure WP-ESD because we believe that the term of water-pocket can be applied comprehensively to the procedure performed with various solutions. We also preliminarily compared the efficacy of WP-ESD with that of PCM-ESD and confirmed that dissection with WP-ESD tended to be faster than with PCM-ESD, especially in lesions with fibrosis. However, in this study, we proved only the superiority of WP-ESD to “standard ESD” without PCM. As Dr Despott et al1Despott E.J. Hirayama Y. Lazaridis N. et al.Saline immersion therapeutic endoscopy facilitated pocket-creation method for endoscopic submucosal dissection (with video).Gastrointest Endosc. 2019; 89: 652-653Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar mentioned, this point also warrants a further prospective study. Again, we thank Dr Despott et al for their insightful comments and concerns. All authors disclosed no financial relationships relevant to this publication. Saline immersion therapeutic endoscopy facilitated pocket-creation method for endoscopic submucosal dissection (with video)Gastrointestinal EndoscopyVol. 89Issue 3PreviewWe read with interest the article by Harada et al,1 who combined the pocket-creation method (PCM)2-6 for endoscopic submucosal dissection (ESD) with pocket immersion.7-9 This was described as “water-pocket ESD” (WP-ESD) and was found to be faster than standard ESD.1 Full-Text PDF