{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T02:36:31Z","timestamp":1792290991305,"version":"4.4.0"},"reference-count":23,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:00:00Z","timestamp":1760054400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:00:00Z","timestamp":1760054400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["DEN Open"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Gel\u2010immersion endoscopy offers benefits such as buoyancy, traction, and a clear visual field without gas insufflation. While some case reports have described colorectal gel\u2010immersion endoscopic submucosal dissection (Gi\u2010ESD), there have been no consecutive case series. This study aimed to clarify the usefulness of Gi\u2010ESD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single\u2010center retrospective cohort study included consecutive patients with colorectal neoplasms who underwent ESD. Gi\u2010ESD was defined as mucosal incision and submucosal dissection performed under clear gel. The primary outcomes were en bloc and histologic R0 resection rates, whereas the secondary outcomes were procedure time, dissection speed, and adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 260 ESD cases, 29 and 231 were in the Gi\u2010ESD and conventional ESD groups, respectively. Gel was used for submerged or poorly accessible lesions. The Gi\u2010ESD group had a significantly larger tumor diameter (25\u00a0mm vs. 18\u00a0mm,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.001), a higher rate of lesions in the cecum or ascending colon (55.2%\u00a0vs. 31.2%,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.01), and more lesions with ESD difficulty factors (24.1%\u00a0vs. 9.5%,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.05). There were no significant differences in the en bloc resection (100%\u00a0vs. 99.1%), histologic R0 resection (96.6%\u00a0vs. 88.7%), or adverse events. In the propensity score\u2010matched cohort, the histologic R0 resection rate was significantly higher in the Gi\u2010ESD group (100%\u00a0vs. 82.6%,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.045). Procedure time was significantly longer in the Gi\u2010ESD group (45\u00a0vs. 29.5\u00a0min,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.006), with no significant difference in dissection speed (14.9 vs. 19.2 mm\n                      <jats:sup>2<\/jats:sup>\n                      \/min,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.19).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Gi\u2010ESD may be an alternative approach for treating submerged gravity\u2010side or poorly approached colorectal lesions.<\/jats:p>\n                  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