Underwater endoscopic mucosal resection for complete R0 removal of colorectal polyp in a patient with ulcerative colitis

Hosotani, Kazuya; Inoue, Satoko; Takahashi, Kana; Hara, Shigeo; Inokuma, Tetsuro

doi:10.1055/a-1346-8769

Cited by 5 publications

(4 citation statements)

References 5 publications

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“…Although this advantage of UEMR was already described in retrospective analyses, the technique and efficacy are worthy of publication as case reports for provision of information because these lesions are difficult to remove using conventional procedures like CEMR or ESD. Two other case reports described UEMR in patients with ulcerative colitis 55,56 . The persistent inflammation in ulcerative colitis causes submucosal fibrosis that makes endoscopic removal difficult by CEMR or ESD.…”

Section: Uemr In Case Reports Under Special Situationsmentioning

confidence: 99%

“…Two other case reports described UEMR in patients with ulcerative colitis. 55 , 56 The persistent inflammation in ulcerative colitis causes submucosal fibrosis that makes endoscopic removal difficult by CEMR or ESD. Therefore, these case reports demonstrate one of the greatest advantages of UEMR, namely its efficacy for the removal of lesions with fibrosis.…”

Section: Uemr In Case Reports Under Special Situationsmentioning

confidence: 99%

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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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Section: Uemr In Case Reports Under Special Situationsmentioning

confidence: 99%

Section: Uemr In Case Reports Under Special Situationsmentioning

confidence: 99%

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

2022

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“…Underwater EMR is particularly advantageous for resecting ulcerative colitis-associated neoplasia (UCAN) compared with conventional EMR, especially in areas of scarring and severe submucosal fibrosis that hinder lifting of the lesion [ 83 ]. Underwater EMR has demonstrated safety, efficacy, and time-saving benefits, effectively removing large polyps in ulcerative colitis with SMF through the ‘heat-sink’ and ‘floating’ effects [ 84 ].…”

Section: Colitis-associated Neoplasiamentioning

confidence: 99%

Interventional endoscopy in inflammatory bowel disease: a comprehensive review

Pal,

Reddy

2023

Gastroenterology Report

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Interventional endoscopy can play a key role in the multidisciplinary management of complex inflammatory bowel disease (IBD) as an adjunct to medical and surgical therapy. The primary role of interventional IBD (IIBD) includes the treatment of Crohn’s disease-related stricture, fistula, and abscess. Endoscopic balloon dilation (EBD), endoscopic stricturotomy, and placement of endoscopic stents are different forms of endoscopic stricture therapy. EBD is the most widely used therapy whereas endoscopic stricturotomy has higher long-term efficacy than EBD. Fully covered and partially covered self-expanding metal stents are useful in long and refractory strictures whereas lumen-apposing metal stents can be used in short, and anastomotic strictures. Endoscopic fistula/abscess therapy includes endoscopic fistulotomy, seton placement, endoscopic ultrasound-guided drainage of rectal/pelvic abscess, and endoscopic injection of filling agents (fistula plug/glue/stem cell). Endoscopic seton placement and fistulotomy are mainly feasible in short, superficial, single tract fistula and in those with prior surgical seton placement. Similarly, endoscopic fistulotomy is usually feasible in short, superficial, single-tract fistula. Endoscopic closure therapies like over-the-scope clips, suturing, and self-expanding metal stent should be avoided for de novo/bowel to hollow organ fistulas. Other indications include management of postoperative complications in IBD such as management of surgical leaks and complications of pouchitis in ulcerative colitis. Additional indications include endoscopic resection of ulcerative colitis-associated neoplasia (by endoscopic mucosal resection, endoscopic submucosal dissection, and endoscopic full-thickness resection), retrieval of retained capsule endoscope, and control of bleeding. IIBD therapies can potentially act as a bridge between medical and surgical therapy for properly selected IBD patients.

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“…Underwater EMR can be particularly beneficial in resecting UCAN compared to conventional EMR in areas of scarring and severe submucosal fibrosis (SMF) hindering lifting of the lesion [47]. UEMR is safe, effective and time-saving which have shown to remove large polyps in UC with submucosal fibrosis by "heatsink" and "floating" effects (Figure 3 E-F) [48].…”

Section: Endoscopic Mucosal Resectionmentioning

confidence: 99%

Role of Interventional IBD in Management of Ulcerative Colitis(UC)-Associated Neoplasia and Post-Operative Pouch Complications in UC: A Systematic Review

Pal¹,

Banerjee²,

Ramchandani³

et al. 2022

Ulcerative Colitis - Etiology, Diagnosis, Diet, Special Populations, and the Role of Interventional Endoscopy

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Interventional inflammatory bowel disease (IIBD) is going to play a major role in complex IBD including ulcerative-colitis associated neoplasia (UCAN) and postoperative complications after ileal pouch-anal anastomosis (IPAA) in ulcerative colitis (UC). We performed a literature search in PubMed using keywords such as “UCAN” and “endoscopic management of pouch complications,” After screening 1221 citations, finally, 91 relevant citations were identified for the systematic review. Endoscopic recognition of dysplasia should be done by high-definition white light endoscopy (HD-WLE) or dye-based/virtual chromoendoscopy (CE) especially in known dysplasia or primary sclerosing cholangitis (PSC). Endoscopically visible lesions without deep submucosal invasion can be resected endoscopically with endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), or using full-thickness resection device (FTRD). Image-enhanced endoscopy (IEE) and IIBD have an emerging role in screening, diagnosis, and management of colitis-associated neoplasia in UC and can avoid colectomy. IIBD can manage a significant proportion of post-IPAA complications. Pouch strictures can be treated with endoscopic balloon dilation (EBD) or stricturotomy, whereas acute and chronic anastomotic leak or sinuses can be managed with through the scope (TTS)/over the scope clips (OTSC) and endoscopic fistulotomy/sinusotomy.

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Underwater endoscopic mucosal resection for complete R0 removal of colorectal polyp in a patient with ulcerative colitis

Cited by 5 publications

References 5 publications

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

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

Interventional endoscopy in inflammatory bowel disease: a comprehensive review

Role of Interventional IBD in Management of Ulcerative Colitis(UC)-Associated Neoplasia and Post-Operative Pouch Complications in UC: A Systematic Review

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