Pocket-creation method (PCM) is a noninferior option to conventional endoscopic submucosal dissection (ESD) for gastric tumors, with lower subsequent surgery rates.

• Overall post-ESD adverse event rates: 14.3% for PCM vs. 12.9% for conventional, demonstrating noninferiority with an absolute risk difference of 1.4%.
• Comparable resection rates: En bloc resection at 98.6% for both methods and complete resection at 92.9% for PCM versus 88.6% for conventional.

Implementing PCM may reduce the need for follow-up surgeries, improving patient outcomes in gastric ESD.

• Subsequent surgical operations were significantly lower in the PCM group (2.9%) compared to the conventional group (12.9%).