Underwater versus conventional EMR of large nonpedunculated colorectal lesions: a multicenter randomized controlled trial

Sánchez, Joaquín Rodríguez; Álvarez-González, Marco A.; Pellisé, María; Coto-Ugarte, David; Uchima, Hugo; Aranda-Hernández, Javier; García, José Santiago; Marín-Gabriel, José Carlos; Pons, Francesc; Nogales, Óscar; Macian, Ramiro Carreño; Herreros–de–Tejada, Alberto; Hernández, Luis; Patrón, G Oliver; Rodríguez-Téllez, Manuel; Redondo–Cerezo, Eduardo; Alonso, Mónica Sánchez; Daca, María; Valdivielso-Cortazar, Eduardo; Álvarez, Alberto; Enguita, Mónica; Montori, Sheyla; Albéniz, Eduardo

doi:10.1016/j.gie.2022.12.013

Cited by 24 publications

(37 citation statements)

References 27 publications

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“…This study showed that by applying underwater cap suction in a similar manner to band ligation EMR (but without deploying a rubber band), the target tissue protrudes intraluminally and adopts a polypoid form that floats underwater before snare resection. As suction is stopped once the pseudopolyp is formed, the risk of perforation should be as low as during UEMR without cap suction pseudopolyp formation, which, based on our experience, is similar to the complication rate of conventional EMR [10].…”

Section: Discussionsupporting

confidence: 65%

“…In a recent randomized controlled trial for nonpedunculated colorectal lesions > 20 mm without previous treatment, UEMR was found to be superior to EMR in terms of lower recurrence rates for 20-30 mm lesions [10]. UEMR was also faster and easier, with similar safety and overall effectiveness.…”

Section: Discussionmentioning

confidence: 95%

“…Underwater EMR (UEMR) has emerged as a technique [9] that, by avoiding submucosal injection, might be helpful in situations where excessive submucosal injection could make EMR difficult (e. g. nonlifting, narrow spaces) [10][11][12]. Endoscopic ultrasound has revealed that mucosa and submucosa "float" and separate from the muscle layer underwater [13].…”

Section: Introductionmentioning

confidence: 99%

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Underwater cap-suction pseudopolyp formation for endoscopic mucosal resection: a simple technique for treating flat, appendiceal orifice or ileocecal valve colorectal lesions

et al. 2023

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Background We aimed to evaluate the safety, and technical success of an easy-to use technique that applies underwater cap-suction pseudopolyp formation to facilitate the resection of flat or from appendiceal orifice or ileocecal valve colorectal lesions. Methods We retrospectively analyzed a register of consecutive Cap-suction pseudolopyp formation during underwater EMR (CAP-UEMR) in two centers, between September 2020 and December 2021. We performed the procedures using a conic-shape cap with 7mm length from the tip to suction the lesion while submerged underwater, followed by underwater snare resection. Our primary endpoint was technical success, defined as macroscopic complete resection. Results We treated 83 lesions (median size 20mm; interquartile range [IQR] 15–30mm)) with CAP-UEMR: 64 depressed or flat component lesions (18 previously manipulated, 9 with difficult access), 11 from the appendix, 8 from the ileocecal valve. Technical success was 100%. There were 7 intraprocedural bleeding and 2 delayed bleeding, all managed endoscopically. No perforations or other complications ocurred. Among the 64 lesions with follow-up colonoscopy, only one recurrence was detected and treated endoscopically. Conclusions Our findings suggest that CAP-UEMR is a safe and effective technique for removing nonpolypoid colorectal lesions, including those arising from the appendiceal orifice or ileocecal valve.

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Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

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Underwater cap-suction pseudopolyp formation for endoscopic mucosal resection: a simple technique for treating flat, appendiceal orifice or ileocecal valve colorectal lesions

et al. 2023

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“…[9] Nevertheless, the results of initial randomized controlled trials comparing the two methods were conflicting [10][11][12][13][14]. In the past three years this topic has been informed by several larger randomized trials [15,16]. The aim of our study was to address the relative safety and efficacy of UEMR and CEMR by synthesizing the most contemporary evidence.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…conducted for a subgroup of three studies that investigated large colorectal lesions (>15mm) [10,11,16].…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Underwater versus conventional endoscopic mucosal resection for colorectal lesions: An updated meta-analysis of randomized controlled trials

Chowdhury,

Kim,

et al. 2023

Endosc Int Open

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Background Colorectal malignancy is a leading cause of death. Conventional endoscopic mucosal resection (CEMR) is a strategy used to resect precancerous lesions which involves injecting fluid beneath a polyp to create a gap for resection. Underwater endoscopic mucosal resection (UEMR) is a newer method that forgoes injection, instead filling the intestinal cavity with water to facilitate polyp resection. Our aim was to compare the safety and efficacy of these approaches by synthesizing the most contemporary evidence. Methods PubMed, Embase, and Cochrane libraries were searched from inception through November 11, 2022 for randomized controlled trials (RCTs) comparing UEMR and CEMR for resection of colorectal lesions. The primary outcome was rates of en bloc resection and secondary outcomes included recurrence, procedure time, and adverse events. Results A total of 2539 studies were identified through our systematic literature search. After screening, 7 RCTs with a total of 1581 polyps were included. UEMR was associated with significantly increased rates of en bloc resection (RR 1.18 [1.03, 1.35]; I2= 76.6%) versus conventional approaches. No significant differences were found in procedure time, recurrence, or adverse events. Conclusion: UEMR is a promising effective technique for removal of colorectal lesions. The most contemporary literature indicates that it improves en bloc resection rate without increasing procedure time, recurrence, or adverse events (PROSPERO ID CRD42022374935).

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Underwater Versus Conventional Endoscopic Mucosal Resection for Colorectal Laterally Spreading Tumors: A Post Hoc Analysis of Efficacy

Le,

Quach

2024

JGH Open

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Background and AimsUnderwater endoscopic mucosal resection (UEMR) has emerged as a promising alternative to conventional endoscopic mucosal resection (CEMR) for the treatment of colorectal laterally spreading tumors (LSTs). This study aimed to compare the efficacy and safety of UEMR and CEMR in managing LSTs measuring 10–30 mm.MethodsA post hoc analysis was performed on 88 patients with 88 colorectal LSTs, who were randomly assigned to two treatment groups: 42 with CEMR and 46 with UEMR. The primary outcome was the rate of R0 resection, defined as the absence of neoplastic cells at the resection margin. The secondary outcomes included en bloc resection rates, procedure times, and postprocedural complications. The data were analyzed via chi‐square tests, t tests, and the Mann–Whitney U test where appropriate.ResultsNo significant difference was found in the R0 resection rate between UEMR and CEMR. However, UEMR achieved a significantly higher en bloc resection rate, particularly for LSTs ranging from 20 to 30 mm (42.9% for CEMR vs. 100% for UEMR; p = 0.009). Additionally, UEMR resulted in a shorter median procedure time (85.0 s for UEMR vs. 207.5 s for CEMR; p < 0.001). There was no significant difference in bleeding complications or the number of clips used between the two groups.ConclusionsCompared with CEMR, UEMR offers a higher en bloc resection rate and a shorter procedure time, particularly for larger lesions, without increasing the risk of complications. UEMR should be considered a preferred option for managing colorectal LSTs, especially those measuring 20–30 mm.

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Underwater versus conventional EMR of large nonpedunculated colorectal lesions: a multicenter randomized controlled trial

Cited by 24 publications

References 27 publications

Underwater cap-suction pseudopolyp formation for endoscopic mucosal resection: a simple technique for treating flat, appendiceal orifice or ileocecal valve colorectal lesions

Underwater cap-suction pseudopolyp formation for endoscopic mucosal resection: a simple technique for treating flat, appendiceal orifice or ileocecal valve colorectal lesions

Underwater versus conventional endoscopic mucosal resection for colorectal lesions: An updated meta-analysis of randomized controlled trials

Underwater Versus Conventional Endoscopic Mucosal Resection for Colorectal Laterally Spreading Tumors: A Post Hoc Analysis of Efficacy

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