Mucosectomía endoscópica bajo el agua: una técnica segura y efectiva entre la mucosectomía convencional y la disección submucosa

Abstract

Background: Underwater endoscopic mucosal resection (UEMR) emerges as a less complex alternative to endoscopic submucosal resection (ESD) for the treatment of colorectal lesions. We present two clinical cases of complex colon adenomas resolved using UEMR technique. Case 1: A 56-years-old male patient with an adenoma identified at the splenic flexure, detected during a screening colonoscopy, whose biopsy revealed low-grade dysplasia. A flat elevated lesion of approximately 30 mm is identified, with a mixed granular lateral spread (LST-GM) and a centrally elevated area as the dominant nodule (0-IIa+Is), without signs of deep invasion. UEMR is performed, achieving a complete block resection. Case 2: A 62-year-old female patient referred for endoscopic resection of a complex adenoma in the transverse colon. A type 0-IIa lesion is observed with a smooth convergence of folds towards its periphery, approximately 15 mm in size, and a non-categorical crypt pattern of submucosal invasion. Insufflation and peristalsis tests did not show categorical elements of deep invasion. Resection is performed in sections using the UEMR technique, without complications. Conclusion: UEMR appears as a more effective alternative than conventional endoscopic mucosal resection (CEMR) and simpler and more accessible than ESD for the resection of colon adenomas larger than 20 mm, supported by controlled clinical studies. However, a more in-depth evaluation of its scope, effectiveness, and safety is still required to establish its role in regular endoscopic practice.