Curative value of underwater endoscopic mucosal resection for submucosally invasive colorectal cancer

Fukuda, Hiromu; Takeuchi, Yoji; Shoji, Ayaka; Miyake, Muneaki; Matsueda, Katsunori; Inoue, Takahiro; Waki, Kotaro; Shimamoto, Yusaku; Kono, Mitsuhiro; Iwagami, Hiroyoshi; Nakahira, Hiroko; Matsuura, Noriko; Maekawa, Akira; Kanesaka, Takashi; Yamamoto, Sachiko; Higashino, Koji; Ishihara, Ryu

doi:10.1111/jgh.15513

Cited by 18 publications

(26 citation statements)

References 37 publications

(47 reference statements)

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“…To date, there has been no report examining the submucosal resection depth by endoscopic resection for NADET. Recently, Fukuda et al 19 . reported the feasibility of colorectal U‐EMR, compared with C‐EMR, in terms of vertical‐margin involvement for submucosally invasive colorectal cancer.…”

Section: Discussionmentioning

confidence: 99%

Resectability of underwater endoscopic mucosal resection for duodenal tumor: A single‐center, retrospective pilot study

Toya

Endo

Yamazato

et al. 2021

J of Gastro and Hepatol

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Background and Aim Underwater endoscopic mucosal resection (U‐EMR) has been attracting much attention as treatment for patients with nonampullary duodenal epithelial tumors (NADETs). We aim to compare treatment outcomes, including submucosal resectability, between patients undergoing U‐EMR and conventional endoscopic mucosal resection (C‐EMR) for NADET. Methods We conducted a retrospective review of 38 patients with NADET treated by U‐EMR or C‐EMR. In the resected specimens, we measured the horizontal length, the vertical distance from the muscularis mucosa to the margin at the deepest site, and the overall submucosal area. The submucosal index (SMI) was defined as the overall submucosal area divided by the largest horizontal length. These values and other treatment outcomes were compared between NADETs resected by U‐EMR and C‐EMR. Results The median size of lesions was 7 mm with a range of 3–13 mm. Although the incidence of adverse events and the rates of en bloc and R0 resection were not different in the two groups, the median procedure time was significantly shorter in the U‐EMR group (11 min vs 13 min; P = 0.045). The median submucosal depth at the deepest site (1.22 mm vs 1.08 mm; P = 0.38) and the median SMI (0.44 vs 0.41; P = 0.42) were not different between groups. Conclusions The resectability between NADETs treated by U‐EMR and C‐EMR was comparable. These results, together with the shorter procedure time required for U‐EMR, suggest that U‐EMR may have the potential to be the first choice for small to medium‐sized NADET.

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Section: Discussionmentioning

confidence: 99%

Resectability of underwater endoscopic mucosal resection for duodenal tumor: A single‐center, retrospective pilot study

Toya

Endo

Yamazato

et al. 2021

J of Gastro and Hepatol

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“…Because EMR and UEMR is reportedly comparable about the depth of submucosal incision, 24 there are no reports comparing UEMR and ESD, and ESD is preferred for lesions with possibility of invasive cancer. On the basis of these results, we would like to propose the following strategy: for lesions < 15 mm suspected as adenoma or intramucosal cancer, UEMR with lesser burden on patients and medical resources is indicated; and for lesions > 15 mm or those suspected to be cancerous, ESD with high en bloc resection rate is indicated.…”

Section: Discussionmentioning

confidence: 99%

Propensity score‐matched analysis of endoscopic resection for recurrent colorectal neoplasms: A pilot study

Ohmori

Yamasaki

Iwagami

et al. 2021

J of Gastro and Hepatol

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Background and Aim Local residual/recurrent colorectal lesions after endoscopic resection (ER) are difficult to treat with conventional ER. Underwater endoscopic mucosal resection (UEMR) and endoscopic submucosal dissection (ESD) are reportedly effective. We investigated the appropriate indications of ESD and UEMR for recurrent colorectal lesions. Methods This single‐center, retrospective, observational study was conducted at a tertiary cancer institute. Patients who underwent UEMR or ESD for residual/recurrent colorectal lesions after ER from October 2013 to February 2019 were enrolled. Propensity score matching was performed between the UEMR and ESD groups to compare the clinical characteristics, treatment, and outcomes. Results In total, 30 UEMRs and 21 ESDs were performed. Median (range) diameter of the lesions was 8 mm (2–22 mm) in UEMR and 15 mm (2–58 mm) in ESD. Median procedure time in UEMR was significantly shorter than that of ESD (4 min [2–15 min] vs 70 min [17–193 min], P < 0.001). En bloc and complete resection rates of ESD were significantly higher than that of UEMR (73% vs 100%, 41% vs 81%, respectively). No adverse events occurred with UEMR, but there were two cases (10%) of delayed perforation with ESD. Neither group reported recurrence after treatment. Propensity score‐matched cases showed significantly shorter procedure time and hospitalization period in UEMR than in ESD. Conclusions The outcomes of UEMR and ESD were comparable. UEMR could be a useful salvage therapy for small local residual/recurrent colorectal lesions after ER with shorter procedure time and hospitalization period.

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“… 18 Meanwhile, the dissection depth of UEMR is comparable to that of CEMR. 19 Therefore, UEMR can be a standard procedure for small colorectal polyps suspicious for high‐grade dysplasia to avoid incomplete removal of occult invasive cancer (Figure 2 , Video 1 ).…”

Section: Outcomes Of Uemr For Small‐size (<10 Mm) Colorectal Polypsmentioning

confidence: 99%

Underwater endoscopic mucosal resection for colorectal lesions: Can it be an “Underwater” revolution?

2022

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Underwater endoscopic mucosal resection (UEMR) is a newly developed technique for the removal of colorectal, duodenal, esophageal, gastric, ampullary, and small intestinal lesions. We performed a PubMed literature search for articles reporting UEMR outcomes for colorectal polyps. Four randomized controlled trials, nine non‐randomized prospective trials, 16 retrospective studies, and 27 case reports were selected for assessment of the efficacy and safety of UEMR. We summarized the therapeutic outcomes of UEMR in each category according to the lesion characteristics [small size (<10 mm), intermediate size (10–19 mm), large size (≥20 mm), recurrent lesion, and rectal neuroendocrine tumor], and calculated the incidence of adverse events among the included articles. As the treatment outcomes for small polyps appeared similar between UEMR and conventional endoscopic mucosal resection (CEMR), UEMR can be a standard procedure for small colorectal polyps suspicious for high‐grade dysplasia to avoid incomplete removal of occult invasive cancer by cold snare polypectomy. As UEMR showed satisfactory outcomes for intermediate‐size lesions and recurrent lesions after endoscopic resection, UEMR can be a standard procedure for these lesions. Regarding large lesions and rectal neuroendocrine tumors, comparisons of UEMR with current standard methods for them were lacking, and further investigations are warranted. Adverse events appeared comparable or less frequent for UEMR compared with CEMR but still existed. Therefore, careful implementation of this new technique in clinical practice is important for its widespread use.

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Curative value of underwater endoscopic mucosal resection for submucosally invasive colorectal cancer

Cited by 18 publications

References 37 publications

Resectability of underwater endoscopic mucosal resection for duodenal tumor: A single‐center, retrospective pilot study

Resectability of underwater endoscopic mucosal resection for duodenal tumor: A single‐center, retrospective pilot study

Propensity score‐matched analysis of endoscopic resection for recurrent colorectal neoplasms: A pilot study

Underwater endoscopic mucosal resection for colorectal lesions: Can it be an “Underwater” revolution?

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