Underwater versus conventional EMR for colorectal polyps: systematic review and meta-analysis

Choi, Alyssa Y.; Moosvi, Zain; Shah, Sagar; Roccato, Mary Kathryn; Wang, Andrew Y.; Hamerski, Christopher; Samarasena, Jason

doi:10.1016/j.gie.2020.10.009

Cited by 48 publications

(45 citation statements)

References 19 publications

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“…This hybrid approach has been shown to have lower en bloc resection rate (68.4% vs 91.0%) and complete resection rate (60.6% vs 82.9%) than conventional ESD[ 42 ]. Currently, underwater EMR has been thought to be a safe and effective method with higher rate of en bloc resection and lower rate of recurrence[ 45 ], but no head-to-head comparisons have been done between UMER and ESD.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic submucosal dissection vs endoscopic mucosal resection for colorectal polyps: A meta-analysis and meta-regression with single arm analysis

Lim¹,

Nistala²,

Ng³

et al. 2021

WJG

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BACKGROUND Endoscopic submucosal dissection (ESD) has shown to be effective in management of colorectal neoplasm in the Asian countries, while its implementation in Western countries where endoscopic mucosal resection (EMR) is preferred is still debatable. AIM To compare the surgical, histological, and oncological outcomes between ESD and EMR in the treatment of colorectal polyps, with subgroup analysis comparing the efficacy of ESD and EMR between Japan and the rest of the world. METHODS Embase and Medline databases were searched from inception to October 2020 in accordance with PRISMA guidelines for studies comparing en bloc , complete resection, margin involvement, resection time, need for additional surgery, complications, and recurrence rate of ESD with EMR. RESULTS Of 281344 colorectal polyps from 21 studies were included. When compared to EMR, the pooled analysis revealed ESD was associated with higher en bloc and complete resection rate, and lower lateral margin involvement and recurrence. ESD led to increased procedural time, need for additional surgery, and perforation risk. No significant difference in bleeding risk was found between the two groups. Meta-regression analysis suggested only right colonic polyps correlated with an increased perforation risk in ESD. Confounders including polyp size and invasion depth did not significantly influence the en bloc and complete resection rate, bleeding risk and recurrence. In subgroup analysis, Japan performed better than the rest of the world in both ESD and EMR with perforation risk of 4% and 0.0002%, respectively, as compared to perforation risk of 8% and 1%, respectively, in reports coming from rest of the world. CONCLUSION ESD resulted in better resection outcomes and lower recurrence compared to EMR. With appropriate training, ESD is preferred over EMR as the first-line therapy for resection of colorectal polyps, without restricting to lesions greater than 20 mm and those with high suspicion of submucosal invasion.

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Section: Discussionmentioning

confidence: 99%

Endoscopic submucosal dissection vs endoscopic mucosal resection for colorectal polyps: A meta-analysis and meta-regression with single arm analysis

Lim¹,

Nistala²,

Ng³

et al. 2021

WJG

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“…Although several systematic reviews and meta-analyses of UEMR have already shown efficacy and safety, the superiority of UEMR over CEMR has not been sufficiently examined because it has not been compared with CEMR [10] or has been compared with CEMR in a mixture of cohort studies and RCTs [11][12][13][14]. RCTs are the most effective way to scientifically validate new medical interventions.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Underwater Endoscopic Mucosal Resection for Nonpedunculated Colorectal Polyps: A Systematic Review and Meta-Analysis

Yamashina¹,

Hanaoka²,

Setoyama³

et al. 2021

Cureus

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Recently, underwater endoscopic mucosal resection (UEMR) without submucosal injection was introduced as a new replacement for conventional EMR (CEMR) and was reported to be useful for resecting large colonic polyps. Here, we aimed to assess the efficacy and safety of these two methods by a systematic review and meta-analysis.We comprehensively searched multiple databases until July 2021 to identify randomized controlled trials (RCTs) comparing UEMR with CEMR. The primary outcomes were the proportion of R0 resection and mean procedure time, and the secondary outcomes were the proportion of en bloc resection and all adverse events. Three reviewers independently searched for articles, extracted data, and assessed the risk of bias. We evaluated the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach. This study was registered in www.protocols.io (Protocol Integer ID: 40849).We included six RCTs (1,374 polyps). We judged that a meta-analysis was not available, and the data were summarized narratively for the proportion of R0 resection. Regarding procedure time, UEMR likely resulted in a large reduction (mean difference = −64.3 seconds; 95% confidence interval (CI) = −122.5 to −6.0 seconds; I 2 = 86%; moderate certainty of evidence). UEMR likely resulted in a large increase in en bloc resection (odds ratio = 1.85; 95% CI = 1.15 to 2.98; I 2 = 60%; moderate certainty of evidence). Percentages of adverse events were 0-17% with CEMR and 0-16% with UEMR.In summary, UEMR might have higher efficacy than CEMR in the endoscopic resection of nonpedunculated colorectal polyps, with likely a large reduction in procedure time.

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“…This hybrid approach has been shown to have lower en bloc resection rate (68.4% vs 91.0%) and complete resection rate (60.6% vs 82.9%) than conventional ESD. 43 Currently, underwater EMR has been thought to be a safe and effective method with higher rate of en bloc resection and lower rate of recurrence, 46 but no head-to-head comparisons have been done between UMER and ESD.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Submucosal Dissection vs Endoscopic Mucosal Resection for Colorectal Polyps. A Meta-Analysis 

Lim

Nistala

et al. 2021

Preprint

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Background: This extensive meta-analysis sought to compare the surgical, histological, and oncological outcomes between endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) in the treatment of colorectal polyps, with subgroup analysis comparing the efficacy of ESD and EMR between Japan and the rest of the world. Methods: Embase and Medline databases were searched from inception to October 2020 in accordance with PRISMA guidelines for studies comparing en bloc, complete resection, margin involvement, resection time, need for additional surgery, complications, and recurrence rate of ESD with EMR. Results: 281,344 colorectal polyps from 21 studies were included. When compared to EMR, the pooled analysis revealed ESD was associated with higher en bloc and complete resection rate, and lower lateral margin involvement and recurrence. ESD led to increased procedural time, need for additional surgery, and perforation risk. No significant difference in bleeding risk was found between the two groups. Meta-regression analysis suggested only right colonic polyps correlated with an increased perforation risk in ESD. Confounders including polyp size and invasion depth did not significantly influence the en bloc and complete resection rate, bleeding risk and recurrence. In subgroup analysis, Japan performed better than the rest of the world in both ESD and EMR with perforation risk of 4% and 0.0002%, respectively, as compared to perforation risk of 8% and 1%, respectively, in reports coming from rest of the world.Conclusions: This meta-analysis demonstrated increased safety and efficacy of ESD and EMR done in Japan as compared with the rest of the world.

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Underwater versus conventional EMR for colorectal polyps: systematic review and meta-analysis

Cited by 48 publications

References 19 publications

Endoscopic submucosal dissection vs endoscopic mucosal resection for colorectal polyps: A meta-analysis and meta-regression with single arm analysis

Endoscopic submucosal dissection vs endoscopic mucosal resection for colorectal polyps: A meta-analysis and meta-regression with single arm analysis

Efficacy of Underwater Endoscopic Mucosal Resection for Nonpedunculated Colorectal Polyps: A Systematic Review and Meta-Analysis

Endoscopic Submucosal Dissection vs Endoscopic Mucosal Resection for Colorectal Polyps. A Meta-Analysis

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Underwater versus conventional EMR for colorectal polyps: systematic review and meta-analysis

Cited by 48 publications

References 19 publications

Endoscopic submucosal dissection vs endoscopic mucosal resection for colorectal polyps: A meta-analysis and meta-regression with single arm analysis

Endoscopic submucosal dissection vs endoscopic mucosal resection for colorectal polyps: A meta-analysis and meta-regression with single arm analysis

Efficacy of Underwater Endoscopic Mucosal Resection for Nonpedunculated Colorectal Polyps: A Systematic Review and Meta-Analysis

Endoscopic Submucosal Dissection vs Endoscopic Mucosal Resection for Colorectal Polyps. A Meta-Analysis&nbsp;

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Endoscopic Submucosal Dissection vs Endoscopic Mucosal Resection for Colorectal Polyps. A Meta-Analysis