Propensity score‐matched analysis of endoscopic resection for recurrent colorectal neoplasms: A pilot study

Abstract

Background and Aim Local residual/recurrent colorectal lesions after endoscopic resection (ER) are difficult to treat with conventional ER. Underwater endoscopic mucosal resection (UEMR) and endoscopic submucosal dissection (ESD) are reportedly effective. We investigated the appropriate indications of ESD and UEMR for recurrent colorectal lesions. Methods This single‐center, retrospective, observational study was conducted at a tertiary cancer institute. Patients who underwent UEMR or ESD for residual/recurrent colorectal lesions after ER from October 2013 to February 2019 were enrolled. Propensity score matching was performed between the UEMR and ESD groups to compare the clinical characteristics, treatment, and outcomes. Results In total, 30 UEMRs and 21 ESDs were performed. Median (range) diameter of the lesions was 8 mm (2–22 mm) in UEMR and 15 mm (2–58 mm) in ESD. Median procedure time in UEMR was significantly shorter than that of ESD (4 min [2–15 min] vs 70 min [17–193 min], P < 0.001). En bloc and complete resection rates of ESD were significantly higher than that of UEMR (73% vs 100%, 41% vs 81%, respectively). No adverse events occurred with UEMR, but there were two cases (10%) of delayed perforation with ESD. Neither group reported recurrence after treatment. Propensity score‐matched cases showed significantly shorter procedure time and hospitalization period in UEMR than in ESD. Conclusions The outcomes of UEMR and ESD were comparable. UEMR could be a useful salvage therapy for small local residual/recurrent colorectal lesions after ER with shorter procedure time and hospitalization period.

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

“…Only two retrospective studies investigated the efficacy of UEMR for recurrent lesions after endoscopic resection. 31 , 32 One retrospective analysis compared 36 UEMR and 44 CEMR procedures. 32 It showed that UEMR had significantly better EBR (47% vs. 16%) and endoscopic CRR (89% vs. 32%) than CEMR.…”

“…Table 4 shows literature reports assessed for the efficacy of underwater endoscopic mucosal resection for recurrent colorectal polyps. Only two retrospective studies investigated the efficacy of UEMR for recurrent lesions after endoscopic resection 31,32 . One retrospective analysis compared 36 UEMR and 44 CEMR procedures 32 .…”

“…Because ESD can remove recurrent lesions after a previous attempt for endoscopic mucosal resection, UEMR and ESD were compared in another retrospective study with propensity score matching 31 . Although ESD had significantly better EBR and CRR than UEMR (100% vs. 73% and 81% vs. 41%, respectively), two delayed perforations were seen in 10% of ESD cases and UEMR had a significantly shorter procedure time and hospitalization period compared with ESD.…”

Depth of the cutting plane with underwater and conventional endoscopic mucosal resection: Post‐hoc analysis of a randomized study

“…Several studies have demonstrated the safety and efficacy of UEMR for colorectal lesions. [2][3][4][5][6][7][8][9][10] We performed a prospective randomized controlled trial (RCT) of UEMR and CEMR for 10-to 20-mm sessile colorectal lesions and reported that UEMR achieved a significantly better R0 resection rate than CEMR, without increasing the adverse events or procedure time. 11 Thus, UEMR is expected to become a standard procedure for removing colorectal polyps with a diameter of 10-20 mm.…”

“…as an alternative to CEMR for removing large, flat colorectal neoplasms. Several studies have demonstrated the safety and efficacy of UEMR for colorectal lesions 2–10 . We performed a prospective randomized controlled trial (RCT) of UEMR and CEMR for 10‐ to 20‐mm sessile colorectal lesions and reported that UEMR achieved a significantly better R0 resection rate than CEMR, without increasing the adverse events or procedure time 11 .…”