Usefulness of the Bridge Formation Method for Colorectal Endoscopic Submucosal Dissection: A Propensity Score-Matched Study.

Aims: Colorectal endoscopic submucosal dissection (ESD) has become a standard treatment for superficial colorectal neoplasms worldwide. However, challenges remain in achieving dissection at the precise layer. In this study, we evaluated the effectiveness of a novel ESD technique involving natural traction, referred to as the bridge formation method (BFM).

Methods And Results: The two main features of the BFM are creating a large mucosal flap and leaving normal mucosa on both sides of the lesion until the bridge is made at the end of the procedure. This retrospective study included consecutive patients with 2647 colorectal lesions resected by ESD from September 2003 to December 2023. We divided them into the BFM group and the non-BFM group and conducted propensity score matching.After propensity score matching, 1648 cases were enrolled (824 cases in each group). The en bloc resection rate was significantly higher in the BFM than non-BFM group (99.6% vs. 96.7%,  < 0.01). The R0 resection rate and the average dissection speed (㎟/min) were significantly higher in the BFM than non-BFM group (98.8% vs. 96.4%,  < 0.01, and 18.9 vs. 18.0,  = 0.03). The occurrence rates of perforation and delayed bleeding showed no significant difference between the non-BFM and BFM groups (2.8% vs. 3.6%,  = 0.40, and 1.1% vs. 1.0%,  = 1.00).

Conclusions: The BFM is a suitable method for colorectal ESD as it enables rapid dissection and improves both en bloc resection and R0 resection rates.