Comparison of Underwater vs Conventional Endoscopic Mucosal Resection of Intermediate-Size Colorectal Polyps

Yamashina, Takeshi; Uedo, Noriya; Akasaka, Tomofumi; Iwatsubo, Taro; Nakatani, Yasuki; Akamatsu, Takuji; Kawamura, Takuji; Takeuchi, Yoji; Fujii, Shigehiko; Kusaka, Toshihiro; Shimokawa, Toshio

doi:10.1053/j.gastro.2019.04.005

Cited by 140 publications

(194 citation statements)

References 51 publications

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“…Three studies (2 RCTs and 1 observational study) [11][12][13] reported data on this outcome and showed superiority of UEMR which reached statistical significance; Pooled RR (95 % CI) 0.75 [0.57, 0.98], Cochran Q test P = 0.24, I 2 = 29 % (▶ Fig. 3b).…”

Section: Complete Resection Confirmed By Histologymentioning

confidence: 95%

“…The outcomes of interest included rates of en bloc resection, complete macroscopic resection (defined by complete endoscopic resection of polyp with absence of any macroscopically visible polyp fragments on endoscopic views at the end of resection), recurrent or residual polyps on follow-up colonoscopy, complete resection confirmed by histology, and adverse events (AEs). Regarding the outcome of "complete resection confirmed by histology", two studies reported data as R0 resection defined as en bloc resection with histologically confirmed negative margins [11,12]. One study reported data on incomplete resection rate based on pathologic assessment of biopsies from the resection margin of polyps [13].…”

Section: Outcomes Of Interest and Inclusion Criteriamentioning

confidence: 99%

“…In EMR, the submucosal injection causes the borders of polyps to expand, thereby producing a larger defect after snare resection. In UEMR, floating of mucosa and submucosa over muscularis layer leads to a change in shape of lesions and some flat and sessile lesions become smaller and more polypoid in configuration [11]. Resection of such lesions leads to smaller defects.…”

Section: Reviewmentioning

confidence: 99%

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Underwater vs conventional endoscopic mucosal resection in the management of colorectal polyps: a systematic review and meta-analysis

et al. 2020

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Background Recently, underwater endoscopic mucosal resection (UEMR) has shown promising results in the management of colorectal polyps. Some studies have shown better outcomes compared to conventional endoscopic mucosal resection (EMR). We conducted this systematic review and meta-analysis to compare UEMR and EMR in the management of colorectal polyps. Methods We searched several databases from inception to November 2019 to identify studies comparing UEMR and EMR. Outcomes assessed included rates of en bloc resection, complete macroscopic resection, recurrent/residual polyps on follow-up colonoscopy, complete resection confirmed by histology and adverse events. Pooled risk ratios (RR) with 95 % confidence interval were calculated using a fixed effect model. Heterogeneity was assessed by I2 statistic. Funnel plots and Egger’s test were used to assess publication bias. We used the Newcastle-Ottawa scale (NOS) for assessment of quality of observational studies, and the Cochrane tool for assessing risk of bias for RCTs Results Seven studies with 1291 patients were included; two were randomized controlled trials and five were observational. UEMR demonstrated statistically significantly better efficacy in rates of en bloc resection, pooled RR 1.16 (1.08, 1.26), complete macroscopic resection, pooled RR 1.28 (1.18, 1.39), recurrent/residual polyps; pooled RR 0.26 (0.12, 0.56) and complete resection confirmed by histology; pooled RR 0.75 (0.57, 0.98). There was no significant difference in adverse events (AEs); pooled RR 0.68 (0.44, 1.05). Conclusions This meta-analysis found statistically significantly better rates of en bloc resection, complete macroscopic resection, and lower risk of recurrent/residual polyps with UEMR compared to EMR. We found no significant difference in AEs between the two techniques.

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Section: Complete Resection Confirmed By Histologymentioning

confidence: 95%

Section: Outcomes Of Interest and Inclusion Criteriamentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

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Underwater vs conventional endoscopic mucosal resection in the management of colorectal polyps: a systematic review and meta-analysis

et al. 2020

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“…5 Although several endoscopic techniques, including cold-snare polypectomy, hotsnare polypectomy and endoscopic mucosal resection (EMR), can be applied to treat polyps, [5][6][7] a newer technique, underwater endoscopic mucosal resection (UEMR), has attracted attention for its effectiveness and simplicity. [8][9][10][11][12] During endoscopic polyp removal, the lesional margins must be identified to prevent remnants, but lesions often have unclear margins under conventional white light imaging (WLI). In these cases, chromoendoscopy can be effective; however, it is unavailable underwater.…”

Section: Introductionmentioning

confidence: 99%

Blue laser imaging and linked color imaging improve the color difference value and visibility of colorectal polyps in underwater conditions

Yamasaki

Harada

Yamamoto

et al. 2020

Digestive Endoscopy

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Background and Aim Underwater endoscopic mucosal resection (UEMR) has become widespread for treating colorectal polyps. However, which observational mode is best suited for determining polyp margins underwater remains unclear. To determine the best mode, we analyzed three imaging modes: white light imaging (WLI), blue laser imaging (BLI) and linked color imaging (LCI). Methods Images of consecutive colorectal polyps previously examined by these three modes before UEMR were analyzed according to the degree of underwater turbidity (transparent or cloudy). Color differences between the polyps and their surroundings were calculated using the Commission Internationale d’Eclairage Lab color space in which 3‐D color parameters were expressed. Eight evaluators, who were blinded to the histology, scored the visibility from one (undetectable) to four (easily detectable) in both underwater conditions. The color differences and visibility scores were compared. Results Seventy‐three polyps were evaluated. Sixty‐one polyps (44 adenomatous, 17 serrated) were observed under transparent conditions, and 12 polyps (seven adenomatous, five serrated) were observed under cloudy conditions. Under transparent conditions, color differences for the BLI (8.5) and LCI (7.9) were significantly higher than that of WLI (5.7; P < 0.001). Visibility scores for BLI (3.6) and LCI (3.4) were also higher than that of WLI (3.1; P < 0.0001). Under cloudy conditions, visibility scores for LCI (2.9) and WLI (2.7) were significantly higher than that of BLI (2.2; P < 0.0001 and P = 0.04, respectively). Conclusions BLI and LCI were better observational modes in transparent water; however, BLI was unsuitable for cloudy conditions.

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“…Endoscopic resection using polypectomy snares is a common, standard technique for treating gastrointestinal polyps [1][2][3]. Several safe and effective resection methods are available, including endoscopic mucosal resection, cold snare polypectomy, hot snare polypectomy, and underwater endoscopic mucosal resection [4][5][6]. Accordingly, various commercially available polypectomy snares have been developed.…”

Section: Introductionmentioning

confidence: 99%

Dynamics of endoscopic snares: a new approach towards more practical and objective performance evaluation

et al. 2020

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Comparison of Underwater vs Conventional Endoscopic Mucosal Resection of Intermediate-Size Colorectal Polyps

Cited by 140 publications

References 51 publications

Underwater vs conventional endoscopic mucosal resection in the management of colorectal polyps: a systematic review and meta-analysis

Underwater vs conventional endoscopic mucosal resection in the management of colorectal polyps: a systematic review and meta-analysis

Blue laser imaging and linked color imaging improve the color difference value and visibility of colorectal polyps in underwater conditions

Dynamics of endoscopic snares: a new approach towards more practical and objective performance evaluation

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