Efficacy and histologic accuracy of underwater versus conventional endoscopic mucosal resection for large (>20 mm) colorectal polyps: a comparative review and meta-analysis.

Published on Sep 1, 2021in Gastrointestinal Endoscopy9.427
· DOI :10.1016/J.GIE.2020.12.034
Saurabh Chandan7
Estimated H-index: 7
(Creighton University Medical Center),
Shahab R. Khan8
Estimated H-index: 8
(Rush University Medical Center)
+ 6 AuthorsGursimran Kochhar19
Estimated H-index: 19
(Allegheny Health Network)
Sources
Abstract
ABSTRACT BACKGROUND and AIMS Major limitations of conventional EMR (C-EMR) include high rates of polyp recurrence and low en-bloc resection rates, especially for lesions >20 mm in size. Underwater EMR (U-EMR) has emerged as an alternate technique for en-bloc resection of larger lesions. We conducted a systematic review and meta-analysis comparing efficacy and safety of the 2 techniques. METHODS Multiple databases were searched through June 2020 for studies that compared outcomes of U-EMR and C-EMR for colorectal lesions. Meta-analysis was performed to determine pooled odds ratios of successful R0, en-bloc and piecemeal resection of colorectal lesions. We compared the rates of polyp recurrence at follow-up, diagnostic accuracy for colorectal cancer (CRC) and adverse events with the 2 techniques. RESULTS Eleven studies, including 4 randomized controlled trials (RCTs) with 1851 patients were included in the final analysis. A total of 1071 lesions were removed using U-EMR, and 1049 lesions were removed using C-EMR. Although U-EMR had an overall superior en-bloc resection rate compared with C-EMR (OR, 1.9; 95% CI, 1-3.5; p=0.04), both techniques were comparable in terms of polyps >20 mm in size (OR, 0.8; 95% CI, 0.3-2.1; p=0.75), R0 resection (OR, 3.1; 95% CI, 0.74-12.6; p=0.14), piecemeal resection (OR, 3.1; 95% CI, 0.74-12.6; p=0.13) and diagnostic accuracy for CRC (OR, 1.1; 95% CI, 0.6-1.8; p=0.82). There were lower rates of polyp recurrence (OR, 0.3; 95% CI, 0.1-0.8; p=0.01) and incomplete resection (OR, 0.4; 95% CI, 0.2-0.5; p=0.001) with U-EMR. Both techniques have comparable resection times and safety profile. CONCLUSIONS Our results support the use of U-EMR over C-EMR for successful resection of colorectal lesions. Further randomized controlled trials are needed to evaluate the efficacy of U-EMR for resecting polyps >20 mm in size.
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#2Bin Ma (PRC: China Medical University (PRC))H-Index: 3
Last. Wenya Li (PRC: China Medical University (PRC))H-Index: 6
view all 5 authors...
Underwater endoscopic mucosal resection (UEMR) of colorectal lesions is emerging as an alternative method to conventional endoscopic mucosal resection (CEMR). This study aimed to evaluate the feasibility and safety of UEMR for colorectal lesions. The PubMed, Embase, Cochrane and Web of Science databases were searched before May 10, 2020. The primary outcomes were en bloc resection rate (feasibility) and adverse event rate (safety). The secondary outcome was recurrence and residual adenoma rate. ...
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#2Joseph Leung (UC Davis: University of California, Davis)H-Index: 72
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view all 4 authors...
Abstract Background and Aims Incomplete resection of colorectal neoplasia decreases colonoscopy efficacy. Conventional resection (CR) of polyps, performed in a gas-distended colon, is the current standard, but incomplete resection rates of approximately 2% to 30% for nondiminutive (>5 mm), nonpedunculated lesions are reported. Underwater resection (UR) is a novel technique. The aim of this study was to determine the incomplete resection rates of colorectal lesions removed by UR versus CR. Method...
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#1Robert L. Barclay (Vancouver General Hospital)H-Index: 1
#2Dean B. Percy (Vancouver General Hospital)H-Index: 1
Abstract Background: Underwater endoscopic mucosal resection without submucosal injection (UEMR) is an appealing therapy for large colorectal polyps. However, this technique is not practiced widely and there are limited data evaluating UEMR in community settings. Methods: The study comprised patients undergoing UEMR of large (≥20 mm) sessile colorectal lesions at a community-based center. Residual neoplasia was assessed via follow-up colonoscopy. Results: Among 264 lesions (diameter 38 ± 18 mm; ...
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#1Vikrant Parihar (Our Lady of Lourdes Hospital)H-Index: 4
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#1Rebecca L. Siegel (ACS: American Cancer Society)H-Index: 68
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Last. Ahmedin Jemal (ACS: American Cancer Society)H-Index: 139
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Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States and compiles the most recent data on population-based cancer occurrence. Incidence data (through 2016) were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data (through 2017) were collected by the National Center for Health Statis...
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#2Noriya UedoH-Index: 59
Last. Ping-Hsin Hsieh (CUA: The Catholic University of America)H-Index: 6
view all 3 authors...
Background and study aims Endoscopic mucosal resection (EMR) is a standard method for removing sessile colorectal polyps ≥ 10 mm. Recently, underwater EMR (UEMR) has been introduced as a potential alternative. However, the effectiveness and safety of UEMR compared with conventional EMR is un clear. Patients and methods In this 1:1 propensity score (PS) matched retrospective cohort study, we compared the en bloc resection rates, procedure time, intraprocedural and delayed bleeding rates, and inci...
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#1Takeshi YamashinaH-Index: 18
#2Noriya UedoH-Index: 59
Last. Toshio Shimokawa (Wakayama Medical University)H-Index: 25
view all 11 authors...
Background & Aims Endoscopic mucosal resection (EMR) with submucosal injection is an established method for removing colorectal polyps, although the en bloc resection rate decreases when polyp size exceeds 10 mm. Piecemeal resection increases local recurrence. Underwater EMR (UEMR) is an effective technique for removal of sessile colorectal polyps and we investigated whether it is superior to conventional EMR (CEMR). Methods We conducted a multicenter randomized controlled trial at 5 institution...
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BACKGROUND AND AIMS: underwater endoscopic mucosal resection (U-EMR) has been recently described as an alternative to endoscopic mucosal resection (EMR) for flat colorectal polyps. However, the real applications remain unclear due to the lack of comparative studies. METHODS: a multi-centric prospective study was performed from November 2016 to December 2017. All lesions larger than 15 mm that were resected with both techniques were included in the study. The samples were matched using the size, ...
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Cited By4
Newest
#1S Nagl (Augsburg College)H-Index: 1
#2Alanna Ebigbo (Augsburg College)H-Index: 14
Last. Agnieszka Jowita Kafel (Augsburg College)H-Index: 1
view all 12 authors...
Background & Aims null Conventional endoscopic mucosal resection (CEMR) with submucosal injection is the current standard for the resection of large, nonmalignant colorectal polyps. We investigated whether underwater endoscopic mucosal resection (UEMR) is superior to CEMR for large (20–40mm) sessile or flat colorectal polyps. null Methods null In this prospective randomized controlled study, patients with sessile or flat colorectal polyps between 20 and 40 mm in size were randomly assigned to UE...
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#1Chih-Wei Tseng (TCU: Tzu Chi University)H-Index: 13
#2Yu-Hsi Hsieh (TCU: Tzu Chi University)H-Index: 10
Last. Felix W. Leung (Veterans Health Administration)H-Index: 51
view all 5 authors...
BACKGROUND Underwater polypectomy without the need for submucosal injection has been reported. A heat-sink effect by immersing the polyp in water was proposed but no such experiment has been performed to support the claim. We compared the temperature rise on the serosal side during polypectomy between air- and water-filled colon. METHOD Freshly harvested porcine colons were placed in a metal tray with cautery electrode pad attached to its bottom. An upper endoscope was used with a cap and a rubb...
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#1Raquel OrtigãoH-Index: 1
#2Jochen Weigt (Otto-von-Guericke University Magdeburg)H-Index: 16
Last. Diogo Libânio (University of Porto)H-Index: 15
view all 4 authors...
BACKGROUND Colonoscopy with polypectomy substantially reduces the risk of colorectal cancer (CRC) but interval cancers still account for 9% of all CRCs, some of which are due to incomplete resection. AIM The aim of this review is to compare the outcomes of cold and hot endoscopic resection and provide technical tips and tricks for optimizing cold snare polypectomy. RESULTS Cold snare polypectomy (CSP) is the standard technique for small (≤10 mm) colorectal polyps. For large colonic polyps (>10 m...
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