Underwater EMR without submucosal injection: Is less more?

Binmoeller, Kenneth F.

doi:10.1016/j.gie.2019.02.011

Cited by 21 publications

(13 citation statements)

References 20 publications

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“…Although ASEMR in the present study shows a slightly higher complete resection rate (94.1%) than UEMR in the previous study, a head-to-head comparison based on two different studies is not appropriate. Theoretically, given that most rectal NETs invade the submucosa, the lack of submucosal fat tissue beneath the NETs may restrict the tissue buoyancy for UEMR 27 . However, this theoretical limitation may not affect the completeness of resection in UEMR because UEMR can facilitate en bloc snaring of NETs by avoiding distension of rectal lumen.…”

Section: Discussionmentioning

confidence: 99%

Anchoring the snare tip is a feasible endoscopic mucosal resection method for small rectal neuroendocrine tumors

Kim

et al. 2021

Sci Rep

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Small rectal neuroendocrine tumors (NETs) can be treated using cap-assisted endoscopic mucosal resection (EMR-C), which requires additional effort to apply a dedicated cap and snare. We aimed to evaluate the feasibility of a simpler modified endoscopic mucosal resection (EMR) technique, so-called anchored snare-tip EMR (ASEMR), for the treatment of small rectal NETs, comparing it with EMR-C. We retrospectively evaluated 45 ASEMR and 41 EMR-C procedures attempted on small suspected or established rectal NETs between July 2015 and May 2020. The mean (SD) lesion size was 5.4 (2.2) mm and 5.2 (1.7) mm in the ASEMR and EMR-C groups, respectively (p = 0.558). The en bloc resection rates of suspected or established rectal NETs were 95.6% (43/45) and 100%, respectively (p = 0.271). The rates of histologic complete resection of rectal NETs were 94.1% (32/34) and 88.2% (30/34), respectively (p = 0.673). The mean procedure time was significantly shorter in the ASEMR group than in the EMR-C group (3.12 [1.97] vs. 4.13 [1.59] min, p = 0.024). Delayed bleeding occurred in 6.7% (3/45) and 2.4% (1/41) of patients, respectively (p = 0.618). In conclusion, ASEMR was less time-consuming than EMR-C, and showed similar efficacy and safety profiles. ASEMR is a feasible treatment option for small rectal NETs.

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Section: Discussionmentioning

confidence: 99%

Anchoring the snare tip is a feasible endoscopic mucosal resection method for small rectal neuroendocrine tumors

Kim

et al. 2021

Sci Rep

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“…By removing intraluminal air, colonic wall tension is decreased, and water insufflation naturally separates the mucosal layer from the muscularis propria thereby eliminating the need for a submucosal injection. This can also potentially allow the capture of a larger mucosal surface area in the opened snare 45 . e. Colon spasms can make the process of polypectomy difficult and painful.…”

Section: How To Tackle the "Slippery Polyps"mentioning

confidence: 99%

How to Approach Small Polyps in Colon: Tips and Tricks

Mahmood¹,

Aguila²,

Rahman³

et al. 2021

Techniques and Innovations in Gastrointestinal Endoscopy

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“…In combination, layer separation and thermal dissipation are thought to decrease the risk of early and delayed perforation. 13 Although data from large-scale studies are not available, the usefulness of underwater EMR for complete resection and safety for adenomas 20 mm or smaller 14 or for lesions with biopsy scars 15 have been reported.…”

Section: Underwater Emr For Nadetsmentioning

confidence: 99%

Present Status of Endoscopic Submucosal Dissection for Non-Ampullary Duodenal Epithelial Tumors

et al. 2020

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Prediction of histology by endoscopic examination is important in the clinical management of non-ampullary duodenal epithelial tumors (NADETs), including adenoma and adenocarcinoma. The use of a simple scoring system based on the findings of white-light endoscopy or magnified endoscopy with narrow-band imaging is useful to differentiate between Vienna category 3 (C3) and C4/5 lesions. Less invasive endoscopic resection procedures, such as cold snare polypectomy, are quick to perform and convenient for small (<10 mm) C3 lesions. Neoplasms with higher grade histology, such as C4/5 lesions, should be treated by endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), or surgery. Although EMR often requires piecemeal resection, the complication rate is acceptable. Excellent complete resection rates could be achieved by ESD; however, it remains a challenging method considering the high risk of complications. Shielding or closure of the ulcer after ESD is effective at decreasing the risk of delayed bleeding and perforation. Laparoscopic endoscopic cooperative surgery is an ideal treatment with a high rate of en bloc resection and a low rate of complications, although it is limited to high-volume centers. Patients with NADETs could benefit from a multidisciplinary approach to stratify the optimal treatment based on endoscopic diagnoses. Clin Endosc 2020 Jan 15.

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Underwater EMR without submucosal injection: Is less more?

Cited by 21 publications

References 20 publications

Anchoring the snare tip is a feasible endoscopic mucosal resection method for small rectal neuroendocrine tumors

Anchoring the snare tip is a feasible endoscopic mucosal resection method for small rectal neuroendocrine tumors

How to Approach Small Polyps in Colon: Tips and Tricks

Present Status of Endoscopic Submucosal Dissection for Non-Ampullary Duodenal Epithelial Tumors

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