Underwater- Versus Conventional Endoscopic Mucosal Resection of Large Sessile or Flat Colonic Polyps: Preliminary Results of a Prospective Randomized Controlled Trial

Nagl, Sandra; Ebigbo, Alanna; Braun, Georg; Gölder, SK; Neuhaus, Lukas; Probst, Andreas; Römmele, C; Schneider, Annette; Schnoy, Elisabeth; Weber, Tobias; Messmann, Helmut

doi:10.1055/s-0040-1704026

Cited by 1 publication

(5 citation statements)

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“…We searched a total of 218 studies on August 15, 2020 and updated the electronic searches on July 15, 2021 (Figure 1). We finally included six studies with 1,374 polyps that met our inclusion criteria, 675 of which were removed by CEMR and 699 by UEMR [8,9,[27][28][29][30]. Two studies included three pedunculated polyps [8,30], so these polyps were excluded from the meta-analysis.…”

Section: Search Resultsmentioning

confidence: 99%

“…However, the summary of the characteristics included these data. Three studies were original articles [8,9,30], and the remaining three were abstracts only [27][28][29]. Table 1 shows a summary of the characteristics of the included studies.…”

Section: Search Resultsmentioning

confidence: 99%

“…Overall, four studies had a high risk of bias as these showed bias in the outcomes measurement. We included all six studies summarized narratively with the primary outcome of the proportion of R0 resection, and meta-analyses with the primary outcome of procedure time and secondary outcomes [8,9,[27][28][29][30]. We found no unpublished studies.…”

Section: Search Resultsmentioning

confidence: 99%

“…All six studies reported en bloc resection [8,9,[27][28][29][30]. We could include a total of 1,374 polyps in our analysis.…”

Section: En Bloc Resectionmentioning

confidence: 99%

“…All six studies reported all adverse events and included a total of 1,374 polyps [8,9,[27][28][29][30]. One study reported no adverse events [9], and five studies reported adverse events, and almost all of them were delayed bleeding [8,[27][28][29][30] (Table 2). There were 0-17% adverse events with CEMR and 0-16% adverse events with UEMR.…”

Section: All Adverse Eventsmentioning

confidence: 99%

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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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