Effectiveness of underwater endoscopic mucosal resection versus conventional endoscopic mucosal resection for 10 to 20 mm colorectal polyps

Abstract

Background: Endoscopic mucosal resection (EMR) is a standard method commonly for removing 10 to 20 mm colorectal polyps. While the incidence of residual or recurrent after conventional EMR is remarkably high. Underwater endoscopic mucosal resection (UEMR) as an alternative technique to conventional EMR for removing colorectal polyps has high adenoma detection and complete resection rates, improves patient comfort, decreases sedation needs, eliminates the risks associated with submucosal injection, and reduces snare and diathermy-induced mucosal injury. We will conduct a comprehensive systematic review and meta-analysis to compare the effectiveness of these two therapies in the management of 10 to 20 mm colorectal polyps. Methods: PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, China Science and Technology Journal Database and Chinese Biomedical Literature Database will be searched from inception of databases to November 2020 without language limitation. Two reviewers will independently conduct article selection, data collection, and assessment of risk of bias. Any disagreement will be resolved by discussion with the third reviewer. Review Manager Software 5.3 will be used for meta-analysis. The Cochrane risk of bias tool will be used to assess the risk of bias. Results: This study will provide a systematic synthesis of current published data to compare the effectiveness of UEMR and conventional EMR for 10 to 20 mm colorectal polyps. Conclusions: This systematic review and meta-analysis will provide clinical evidence as to whether UEMR is more effective and safer than conventional EMR for 10 to 20 mm colorectal polyps. Study registration number: INPLASY2020100006.

Longly-attached cap can contribute to en bloc underwater endoscopic mucosal resection of 20–30 mm colorectal intramucosal lesions

“…Guidelines regarding intramucosal lesions recommend choosing a resection method according to lesion size, such as the following: CSP for adenomas < 10 mm 3 23 , EMR for lesions 10–20 mm 4 , and EMR or ESD for lesions ≥ 20 mm or that measure more than half the lesion’s circumference 3 4 5 . The reason for the recommendation to perform EMR or ESD for lesions ≥ 20 mm is that with larger lesions, rates of piecemeal resection or submucosal invasion increase 4 5 6 7 8 9 10 11 12 13 14 15 . Therefore, UEMR can be an effective alternative for intramucosal tumors measuring 20–30 mm if the en bloc resection and complication rates with UEMR are comparable to rates with ESD or CEMR for these lesions.…”

“…Underwater endoscopic mucosal resection (UEMR) was reported in 2012 by Binmoeller et al as a new method, during which the intestinal lumen is filled with water without injection into the submucosa 6 . UEMR is effective and safe compared with CEMR in resection of colorectal neoplasms measuring 10–20 mm 7 8 9 10 . UEMR is also performed for lesions measuring ≥ 20 mm as well as for lesions measuring 10–20 mm because of the simplicity and safety 11 .…”

Endoscopic mucosal resection-precutting vs conventional endoscopic mucosal resection for sessile colorectal polyps sized 10-20 mm

“…Furthermore, as previously reported, piecemeal-resected lesions reduced the quality and reliability of histological evaluation[ 24 ], possibly leading to the inability to provide proper additional treatment and recommendations of appropriate surveillance intervals[ 4 , 25 ]. To improve the effectiveness and safety of endoscopic colorectal lesion resection, several improved EMR techniques have been developed, such as EMR-P, underwater EMR (UEMR), anchored EMR, and cap-shaped EMR[ 4 , 26 - 28 ].…”