The clinical efficacy of pocket creation method ESD and conventional ESD in the treatment of early colorectal neoplasms: a meta-analysis

Background This study systematically evaluated the efficacy and safety of the pocket creation method endoscopic submucosal dissection (PCM-ESD) compared with conventional endoscopic submucosal dissection (C-ESD) in the treatment of early colorectal neoplasms. Methods A comprehensive search was conducted across PubMed, The Cochrane Library, Embase, CNKI, VIP, and Wan Fang databases for all case–control studies published from the inception of these databases to June 30, 2025, comparing PCM-ESD with C-ESD in the treatment of early colorectal neoplasms. Literature screening and data extraction were performed in accordance with predefined inclusion and exclusion criteria. Meta-analysis was performed using RevMan 5.4 software to assess the efficacy and safety of both methods. Results Nine studies, including 2 randomized controlled trials and 7 retrospective cohort studies with a total of 1,899 patients, were included. PCM-ESD achieved higher en bloc resection rates (RR = 1.05, 95%CI: 1.02 ~ 1.09, p  = 0.004) and complete (R0) resection rates (OR = 2.34, 95% CI: 1.62–3.39, p  < 00001) than C-ESD. Superior outcomes were also observed in fibrotic lesions (OR 1.67; 95% CI 1.14–2.43; p  = 0.008) and LST-NG-type polyps (OR 1.39; 95% CI 1.09–1.79; p  = 0.009). No significant differences were found in non-curative resection rates (OR 0.83; 95% CI 0.52–1.30; p  = 0.41). PCM-ESD demonstrated shorter procedure time (min) (MD − 10.61; 95% CI − 15.41 to −5.80; p  < 0.0001) and faster dissection speed (mm2/min) (MD 4.56; 95% CI 3.19–5.92; p  < 0.00001). Perforation rates were lower with PCM-ESD (OR 0.41; 95% CI 0.20–0.81; p  = 0.01), while bleeding rates were comparable (OR 1.03; 95% CI 0.51–2.05; p  = 0.94). Specimen size was larger in the PCM-ESD group (MD 2.83; 95% CI 0.66–5.00; p  = 0.01). Postoperative pathology revealed no difference in submucosal invasion depth (OR 0.94; 95% CI 0.69–1.28; p  = 0.69). Conclusion In the treatment of early colorectal neoplasms, PCM-ESD was associated with higher en bloc and R0 resection rates, shorter procedure time, faster dissection speed, and a lower perforation rate compared with C-ESD. In contrast, no statistically significant differences were observed between the two techniques with respect to non-curative resection rates, pathological outcomes, or bleeding-related events. While several efficacy and safety-related indicators favored PCM-ESD, these findings should be interpreted with caution given the predominance of retrospective data and the heterogeneity of study designs. Overall, PCM-ESD appears to be a promising alternative technique, particularly for technically challenging lesions. Systematic review registration https://www.crd.york.ac.uk/prospero/ , CRD420251147333.