Underwater endoscopic colorectal polyp resection: Feasibility in everyday clinical practice

Cadoni, Sergio; Liggi, Mauro; Gallittu, Paolo; Mura, Donatella; Fuccio, Lorenzo; Koo, Malcolm; Ishaq, Sauid

doi:10.1177/2050640617733923

Cited by 29 publications

(46 citation statements)

References 29 publications

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“…Three studies (2 RCTs and 1 observational study) [11][12][13] reported data on this outcome and showed superiority of UEMR which reached statistical significance; Pooled RR (95 % CI) 0.75 [0.57, 0.98], Cochran Q test P = 0.24, I 2 = 29 % (▶ Fig. 3b).…”

Section: Complete Resection Confirmed By Histologymentioning

confidence: 95%

“…The outcomes of interest included rates of en bloc resection, complete macroscopic resection (defined by complete endoscopic resection of polyp with absence of any macroscopically visible polyp fragments on endoscopic views at the end of resection), recurrent or residual polyps on follow-up colonoscopy, complete resection confirmed by histology, and adverse events (AEs). Regarding the outcome of "complete resection confirmed by histology", two studies reported data as R0 resection defined as en bloc resection with histologically confirmed negative margins [11,12]. One study reported data on incomplete resection rate based on pathologic assessment of biopsies from the resection margin of polyps [13].…”

Section: Outcomes Of Interest and Inclusion Criteriamentioning

confidence: 99%

“…▶ Table 2 summarizes data of outcomes of interest. Cadoni et al [12] had also presented data on pedunculated polyps which we did not include in our analysis.…”

Section: Search Strategy Yield and Quality Assessmentmentioning

confidence: 99%

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Underwater vs conventional endoscopic mucosal resection in the management of colorectal polyps: a systematic review and meta-analysis

et al. 2020

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Background Recently, underwater endoscopic mucosal resection (UEMR) has shown promising results in the management of colorectal polyps. Some studies have shown better outcomes compared to conventional endoscopic mucosal resection (EMR). We conducted this systematic review and meta-analysis to compare UEMR and EMR in the management of colorectal polyps. Methods We searched several databases from inception to November 2019 to identify studies comparing UEMR and EMR. Outcomes assessed included rates of en bloc resection, complete macroscopic resection, recurrent/residual polyps on follow-up colonoscopy, complete resection confirmed by histology and adverse events. Pooled risk ratios (RR) with 95 % confidence interval were calculated using a fixed effect model. Heterogeneity was assessed by I2 statistic. Funnel plots and Egger’s test were used to assess publication bias. We used the Newcastle-Ottawa scale (NOS) for assessment of quality of observational studies, and the Cochrane tool for assessing risk of bias for RCTs Results Seven studies with 1291 patients were included; two were randomized controlled trials and five were observational. UEMR demonstrated statistically significantly better efficacy in rates of en bloc resection, pooled RR 1.16 (1.08, 1.26), complete macroscopic resection, pooled RR 1.28 (1.18, 1.39), recurrent/residual polyps; pooled RR 0.26 (0.12, 0.56) and complete resection confirmed by histology; pooled RR 0.75 (0.57, 0.98). There was no significant difference in adverse events (AEs); pooled RR 0.68 (0.44, 1.05). Conclusions This meta-analysis found statistically significantly better rates of en bloc resection, complete macroscopic resection, and lower risk of recurrent/residual polyps with UEMR compared to EMR. We found no significant difference in AEs between the two techniques.

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Section: Complete Resection Confirmed By Histologymentioning

confidence: 95%

Section: Outcomes Of Interest and Inclusion Criteriamentioning

confidence: 99%

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Underwater vs conventional endoscopic mucosal resection in the management of colorectal polyps: a systematic review and meta-analysis

et al. 2020

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“…Of the 18 included studies, eight were conducted in the USA [8,10,[20][21][22][23][24][25], seven in Europe [11,12,[26][27][28][29][30], and three in Asia [9,31,32]. Moreover, there were two RCTs [9, 10], 10 prospective studies [8,12,[22][23][24][26][27][28][29][30], and six retrospective studies [11,20,21,25,31,32] in this meta-analysis. A total of 1093 patients were enrolled, including 566 men, with the mean age ranging from 54.5 to 70 years (Table 1s).…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

“…As a novel technique, underwater EMR (UEMR) can increase the en bloc resection rate and decrease the residual polyp rate for flat colorectal polyps, as was first described by Bimmoeller et al in 2012 [8]. Subsequently, several studies showed that UEMR is effective and safe, and suggested it should be used as an alternative to conventional EMR; however, the results remain controversial [9][10][11][12]. Recently, a meta-analysis revealed that UEMR has an en bloc resection rate of 57.07 %, a residual polyp rate of 8.82 %, and an adverse event rate of 3.31 % [13].…”

Section: Introductionmentioning

confidence: 99%

The efficacy and safety of underwater endoscopic mucosal resection for ≥10-mm colorectal polyps: systematic review and meta-analysis

Lai

Yang

et al. 2020

Endoscopy

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Background Underwater endoscopic mucosal resection (UEMR) is a promising strategy for nonpedunculated colorectal polyp removal. However, the efficacy and safety of the technique for the treatment of ≥ 10-mm colorectal polyps remain unclear. We aimed to comprehensively assess the efficacy and safety of UEMR for polyps sized 10–19 mm and ≥ 20 mm. Methods PubMed, EMBASE, and the Cochrane Library databases were searched for relevant articles from January 2012 to November 2019. Primary outcomes were the rates of adverse events and residual polyps. Secondary outcomes were the complete resection, en bloc resection, and R0 resection rates. Results 18 articles including 1142 polyps from 1093 patients met our inclusion criteria. The overall adverse event and residual polyp rates were slightly lower for UEMR when removing colorectal polyps of 10–19 mm vs. ≥ 20 mm (3.5 % vs. 4.3 % and 1.2 % vs. 2.6 %, respectively). The UEMR-related complete resection rate was slightly higher for colorectal polyps of 10–19 mm vs. ≥ 20 mm (97.9 % vs. 92.0 %). However, the en bloc and R0 resection rates were dramatically higher for UEMR removal of polyps of 10–19 mm vs. ≥ 20 mm (83.4 % vs. 36.1 % and 73.0 % vs. 40.0 %, respectively). In addition, univariate meta-regression revealed that polyp size was an independent predictor for complete resection rate (P = 0.03) and en bloc resection (P = 0.01). Conclusions UEMR was an effective and safe technique for the removal of ≥ 10-mm nonpedunculated colorectal polyps. However, UEMR exhibited low en bloc and R0 resection rates for the treatment of ≥ 20-mm polyps.

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Complicated Polypectomy

Shahidi¹,

Bourke²,

Sano³

et al. 2022

Successful Training in Gastrointestinal Endoscopy

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Underwater endoscopic colorectal polyp resection: Feasibility in everyday clinical practice

Abstract: Underwater polypectomy can be efficaciously used in routine clinical practice for the complete resection of colon polyps, with several advantages over gas insufflation polypectomy.

Cited by 29 publications

References 29 publications

Underwater vs conventional endoscopic mucosal resection in the management of colorectal polyps: a systematic review and meta-analysis

Underwater vs conventional endoscopic mucosal resection in the management of colorectal polyps: a systematic review and meta-analysis

The efficacy and safety of underwater endoscopic mucosal resection for ≥10-mm colorectal polyps: systematic review and meta-analysis

Complicated Polypectomy

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