Marco Spadaccini1, Lorenzo Fuccio2, Laura Lamonaca1, Leonardo Frazzoni2, Roberta Maselli3, Milena Di Leo1, Piera Alessia Galtieri3, Vincenzo Craviotto1, Ferdinando D'Amico1, Cesare Hassan4, Alessandro Repici1. 1. Humanitas Clinical and Research Center, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano (Milano), Italy; Humanitas University, Department of Biomedical Sciences, Rozzano (Milano), Italy. 2. S. Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. 3. Humanitas Clinical and Research Center, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano (Milano), Italy. 4. Nuovo Regina Margherita Hospital, Digestive Endoscopy Unit, Rome, Italy.
Abstract
BACKGROUND AND AIMS: Underwater EMR is an alternative way to have nonpedunculated colorectal lesions lifted before being resected. The endoscopist takes advantage of the behavior of mucosal lesions floating away from the muscular layer, once immersed in liquid. We performed a systematic review with meta-analysis to evaluate the efficacy and safety of this technique. METHODS: Electronic databases (Medline, Scopus, EMBASE) were searched up to May 2018. Full articles including patients with colorectal lesions resected by the underwater EMR technique were eligible. The complete resection (primary outcome), en bloc resection, recurrence, and adverse event rates were pooled by means of a random or fixed-effect model. RESULTS: Ten studies were eligible, providing data on 508 lesions removed from 433 patients (male/female = 239/194; mean age range 62.2-75.0 years). Six studies were performed in the United States and the other in Europe; 7 studies were prospective. The specific indications for performing underwater EMR varied widely across studies. The complete resection rate was 96.36% (95% confidence interval [CI], 91.77-98.44), with a rate of en bloc resection of 57.07% (95% CI, 43.20%-69.91%). The recurrence rate was 8.82% (95% CI, 5.78-13.25) in a mean endoscopy surveillance period of 7.7 months (range 4-15 months). The postprocedural bleeding rate was 2.85% (95% CI, 1.64-4.90). Bleeding during the procedure was always mild and was considered as part of the procedure in all series. The overall adverse event rate was 3.31% (95% CI, 1.97%-5.52%). No cases of perforation were reported. CONCLUSION: According to the results of this systematic review, underwater EMR appears to be an effective and extremely safe technique for resecting nonpolypoid colorectal lesions.
BACKGROUND AND AIMS: Underwater EMR is an alternative way to have nonpedunculated colorectal lesions lifted before being resected. The endoscopist takes advantage of the behavior of mucosal lesions floating away from the muscular layer, once immersed in liquid. We performed a systematic review with meta-analysis to evaluate the efficacy and safety of this technique. METHODS: Electronic databases (Medline, Scopus, EMBASE) were searched up to May 2018. Full articles including patients with colorectal lesions resected by the underwater EMR technique were eligible. The complete resection (primary outcome), en bloc resection, recurrence, and adverse event rates were pooled by means of a random or fixed-effect model. RESULTS: Ten studies were eligible, providing data on 508 lesions removed from 433 patients (male/female = 239/194; mean age range 62.2-75.0 years). Six studies were performed in the United States and the other in Europe; 7 studies were prospective. The specific indications for performing underwater EMR varied widely across studies. The complete resection rate was 96.36% (95% confidence interval [CI], 91.77-98.44), with a rate of en bloc resection of 57.07% (95% CI, 43.20%-69.91%). The recurrence rate was 8.82% (95% CI, 5.78-13.25) in a mean endoscopy surveillance period of 7.7 months (range 4-15 months). The postprocedural bleeding rate was 2.85% (95% CI, 1.64-4.90). Bleeding during the procedure was always mild and was considered as part of the procedure in all series. The overall adverse event rate was 3.31% (95% CI, 1.97%-5.52%). No cases of perforation were reported. CONCLUSION: According to the results of this systematic review, underwater EMR appears to be an effective and extremely safe technique for resecting nonpolypoid colorectal lesions.
Authors: Tiing Leong Ang; Jit Fong Lim; Tju Siang Chua; Kok Yang Tan; James Weiquan Li; Chern Hao Chong; Kok Ann Gwee; Vikneswaran S/O Namasivayam; Charles Kien Fong Vu; Christopher Jen Lock Khor; Lai Mun Wang; Khay Guan Yeoh Journal: Singapore Med J Date: 2020-07-16 Impact factor: 3.331
Authors: Darren Jun Hao Tan; Cheng Han Ng; Xiong Chang Lim; Wen Hui Lim; Linus Zhen Han Yuen; Jin Hean Koh; Kameswara Rishi Yeshayahu Nistala; Khek-Yu Ho; Choon Seng Chong; Mark D Muthiah Journal: Endosc Int Open Date: 2022-01-14