Evaluation of Underwater Endoscopic Mucosal Resection for Colorectal Polyps in an Outpatient Clinic in Brazil

Abstract

BACKGROUND: Since 2012, a new technique for resection of large polyps has been described, the underwater endoscopic mucosal resection (UEMR). Some advantages that emerge from it is the needless of injection in submucosal layer and a greater chance of complete capture of the polyp. OBJECTIVE: There are few studies of UEMR in Brazil. The aim of this study is to evaluate the safety and efficacy of this technique in one Brazilian center. METHODS: This case series was conducted from February to December of 2020. Colorectal polyps greater than 9 mm without features of deep submucosal invasion were resected using UEMR. RESULTS: Twenty-four large polyps were resected with the UEMR approach from 24 patients. The mean size of the polys was 19 mm, ranging from 12 to 35 mm. All lesions were successful resected and 66% (16/24) were resected en bloc. In histologic analyses, most of them were adenomas (70.8%) and only one had deep submucosal invasion. There were no cases of acute complications, such perforation or acute bleeding. CONCLUSION: The UEMR is a safe and feasible procedure. With the emerging data on the procedure, it seems to be a wonderful tool in preventing colorectal cancer and its applicability and scope should be encourage to surpass reference centers.

Endoscopic resection of large non-pedunculated colorectal polyps: current standards of treatment

“…56 The rate of en bloc resection achieved through Underwater EMR (U-EMR) varies in different studies, ranging up to 100% of cases, consequently resulting in a higher rate complete resection and lower recurrence in the following surveillance colonoscopes. [57][58][59][60][61][62][63][64][65][66][67] U-EMR allows for attempting larger lesions en bloc but still struggles for lesions ≥30 mm. In a meta-analysis of 11 studies, the rate of en bloc resection was not different between U-EMR and conventional EMR for polyps >20 mm, but the risk of piecemeal resection was lower in U-EMR, although it did not reach the statistical significance (OR 3.1, p=0.13).…”

Clinical, Surgical and Endoscopy Gastroenterology Must Always Go Together

“…The quality of endoscopic procedures must be evaluated by standards created and used in practice so that we can improve what is offered to patients. Furthermore, an important technical point was the published study of Schacher and cols who evaluated the results of the underwater endoscopic resection of colorectal polyps, a technique that is on the rise due to its effectiveness, improved skills and low complication rate (7) .…”