Underwater versus conventional EMR for nonpedunculated colorectal lesions: a randomized clinical trial

Lenz, Luciano; Martins, Bruno Costa; Paulo, Gustavo Andrade de; Kawaguti, Fábio S.; Baba, Elisa; Uemura, Ricardo S.; Gusmon, Carla; Geiger, Sebastian; Moura, Renata Nobre; Pennacchi, Caterina; Lima, Marcelo Simas de; Safatle‐Ribeiro, Adriana Vaz; Hashimoto, Cláudio L.; Ribeiro, Ulysses; Maluf‐Filho, Fauze

doi:10.1016/j.gie.2022.10.033

Cited by 19 publications

(20 citation statements)

References 37 publications

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“…All included trials in our analysis were prospective with two single-center [27,28] and five multicenter trials. [29][30][31][32][33] All trials originated from different geographical regions including Asia, North America, and Europe.…”

Section: Characteristics and Quality Of Included Studiesmentioning

confidence: 99%

“…In two of the included trials, information regarding blinding of participants and outcome assessment was not reported. [31,32] In all other trials, while the pathologist was blinded to the resection technique, the performing endoscopists were not blinded, which likely resulted in risk of bias in outcomes assessment. Finally, due to the inherent design of the included trials, the performing endoscopists were not blinded to the resection technique, which could have influenced the outcomes.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…There was insufficient data for us to calculate the pooled rates of incomplete resection and recurrence for polyps >20 mm in size. However, based on two studies,[31, 47] a total of 18 out of 148 polyps (12.2%) with This article is protected by copyright. All rights reserved.…”

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confidence: 99%

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Safety and efficacy of underwater versus conventional endoscopic mucosal resection for colorectal polyps: Systematic review and meta-analysis of RCTs

et al. 2023

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Background: Conventional endoscopic mucosal resection (C-EMR) is limited by low en-bloc resection rates, especially for large (>20mm) lesions. Underwater EMR (U-EMR) has emerged as an alternative for colorectal polyps and is being shown to improve en-bloc resection rates. We conducted a systematic review and meta-analysis comparing the two techniques. Methods: Multiple databases were searched through November 2022 for RCTs comparing outcomes of U-EMR and C-EMR for colorectal polyps. Meta-analysis was performed to determine pooled proportions and relative risks (RR) of R0 and en-bloc resection, polyp recurrence, resection time, and adverse events. Results: Seven RCTs with 1458 patients (U-EMR: 739, C-EMR: 719) were included. The pooled rate of en-bloc resection was significantly higher with U-EMR vs C-EMR, 70.17% (CI 46.68-86.34) vs 58.14% (CI 31.59-80.68), respectively, RR 1.21 (CI 1.01-1.44). R0 resection rates were higher with U-EMR vs C-EMR, 58.1% (CI 29.75-81.9) vs 44.6% (CI 17.4-75.4), RR 1.25 (CI 0.99-1.6). For large polyps (>20 mm), en-bloc resection rates were comparable between the two techniques, RR 1.24 (CI 0.83-1.84). Resection times were significantly lesser with U-EMR vs C-EMR, standardized mean difference -1.21 min (CI -2.57, -0.16). Overall pooled rates of perforation, immediate and delayed bleeding were comparable between U-EMR and C-EMR. Pooled rate of polyp recurrence at surveillance colonoscopy was significantly lower with U-EMR, than C-EMR, RR 0.62 (CI 0.41-0.94). Conclusion: Colorectal U-EMR results in higher en-bloc resection rates, lower resection time and recurrence rates compared to C-EMR and both techniques have a comparable safety profile.

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Section: Characteristics and Quality Of Included Studiesmentioning

confidence: 99%

Section: Accepted Manuscriptmentioning

confidence: 99%

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Safety and efficacy of underwater versus conventional endoscopic mucosal resection for colorectal polyps: Systematic review and meta-analysis of RCTs

et al. 2023

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“…(3) Although endoscopic submucosal dissection (ESD) seems to be a good alternative as it allows en bloc resection of large polyps, this technique requires advanced skills and is not widely available. (4,5) Binmoeller et al also designed an alternative method of lesion removal without submucosal injection.…”

Section: Introductionmentioning

confidence: 99%

“…(6) Since the rst description of underwater EMR (UEMR) in 2012, many articles have been published showing reasonable technical success rates, with a low incidence of AEs with UEMR . (3,(5)(6)(7)(8)(9)(10)(11)(12) Previous meta-analyses have included lesions smaller than 10 mm, typically not removed by either CEMR or UEMR or non-randomized studies -inadequate for head-to-head comparisons. (1,(13)(14)(15)(16) The aim of this systematic review and meta-analysis is to evaluate and compare the e cacy and safety outcomes of UEMR and CEMR in lesions ≥ 10mm, analyzing only randomized controlled trials (RCT).…”

Section: Introductionmentioning

confidence: 99%

Underwater versus conventional endoscopic mucosal resection for colorectal lesions: a systematic review and meta-analysis of randomized clinical trials

Souza

Santo

Maluf‐Filho

et al. 2023

Preprint

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Purpose: Conventional endoscopic mucosal resection (CEMR) is the established method for the resection of non-pedunculated colorectal lesions (NPCRL) ≥ 10mm. In the last decade, underwater endoscopic mucosal resection (UEMR) has been introduced as a potential alternative. The aim of this systematic review with meta-analysis is to compare the recurrence and safety of UEMR and CEMR by analyzing only randomized controlled trials (RCTs). Methods: We systematically searched PubMed, Cochrane Library and EMBASE until April 2023. Studies met the following inclusion criteria: (1) RCTs, (2) comparing UEMR with CEMR, (3) NPCRL ≥ 10 mm, and (4) reporting the outcomes of interest. Primary outcomes were recurrence and safety. Secondary outcomes were en bloc, R0, complete resection, clipping and adverse events per type. Results: Five RCTs were included. UEMR was associated with a lower recurrence rate (OR: 0.56; 95% CI: 0.32-0.97). Thus, the RR of recurrence was 1.7 times higher in the CEMR group (95% CI, 1.04-2.77). There was no significant difference in the pooled safety analysis. UEMR showed better en bloc resection rates (OR: 1.54; 95% CI: 1.15-2.07), but subgroup analysis showed comparable rates in lesions ≥20 mm. R0 resection was higher in UEMR (OR: 1.72; 95% CI: 1.23-2.41). Other outcomes were not different between the 2 groups. Conclusions: UEMR is as safe as CEMR, with a higher overall R0 rate and a higher en bloc resection rate for lesions < 20 mm, leading to a lower overall recurrence rate. The results of this meta-analysis support the widespread use of UEMR.

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Underwater versus conventional endoscopic mucosal resection for colorectal lesions: a systematic review and meta-analysis of randomized clinical trials

Souza

Santo

Maluf‐Filho

et al. 2023

Int J Colorectal Dis

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Underwater versus conventional EMR for nonpedunculated colorectal lesions: a randomized clinical trial

Cited by 19 publications

References 37 publications

Safety and efficacy of underwater versus conventional endoscopic mucosal resection for colorectal polyps: Systematic review and meta-analysis of RCTs

Safety and efficacy of underwater versus conventional endoscopic mucosal resection for colorectal polyps: Systematic review and meta-analysis of RCTs

Underwater versus conventional endoscopic mucosal resection for colorectal lesions: a systematic review and meta-analysis of randomized clinical trials

Underwater versus conventional endoscopic mucosal resection for colorectal lesions: a systematic review and meta-analysis of randomized clinical trials

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