Marcello Maida1, Sandro Sferrazza2, Alberto Murino3, Andrea Lisotti4, Nikolaos Lazaridis3, Alessandro Vitello5, Pietro Fusaroli4, Giovanni de Pretis2, Emanuele Sinagra6. 1. Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, Caltanissetta, Italy. marcello.maida@hotmail.it. 2. Gastroenterology and Endoscopy Unit, Santa Chiara Hospital, Trento, Italy. 3. Royal Free Unit for Endoscopy and University College London (UCL) Institute for Liver and Digestive Health, London, UK. 4. Department of Medical and Surgical Sciences, GI Unit, Hospital of Imola, University of Bologna, Bologna, Italy. 5. Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, Caltanissetta, Italy. 6. Gastroenterology and Endoscopy Unit, Instituto San Raffaele Giglio, Cefalù, Italy.
Abstract
BACKGROUND: Conventional endoscopic resection techniques such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), represent the standard of care for treatment of superficial gastrointestinal lesions. In 2012 a novel technique called underwater endoscopic mucosal resection (U-EMR) was described by Binmoeller and colleagues. This substantial variation from the standard procedure was afterwards applied at endoscopic submucosal dissection (U-ESD) and recently proposed also for peroral endoscopic myotomy (U-POEM) and endoscopic full-thickness resection (U-EFTR). METHODS: This paper aims to perform a comprehensive review of the current literature related to supporting the underwater resection techniques with the aim to evaluate their safety and efficacy. RESULTS: Based on the current literature U-EMR appears to be feasible and safe. Comparison studies showed that U-EMR is associated with higher "en-bloc" and R0 resection rates for colonic lesions, but lower "en-bloc" and R0 resection rates for duodenal non-ampullary lesions, compared to standard EMR. In contrast to U-EMR, little evidence supporting U-ESD are currently available. A single comparison study on gastric lesions showed that U-ESD had shorter procedural times and allowed a similar "en-bloc" resection rates compared to standard ESD. No comparison studies between U-ESD and ESD are available for colonic lesions. Finally, only some anecdotal experiences have been reported for U-POEM or U-EFTR, and the feasibility and effectiveness of these techniques need to be further investigated. CONCLUSIONS: Further prospective studies are necessary to better explore the advantages of underwater techniques compared to the respective standards of care, especially in the setting of U-ESD where consistent data are lacking and where standardization of the technique is needed.
BACKGROUND: Conventional endoscopic resection techniques such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), represent the standard of care for treatment of superficial gastrointestinal lesions. In 2012 a novel technique called underwater endoscopic mucosal resection (U-EMR) was described by Binmoeller and colleagues. This substantial variation from the standard procedure was afterwards applied at endoscopic submucosal dissection (U-ESD) and recently proposed also for peroral endoscopic myotomy (U-POEM) and endoscopic full-thickness resection (U-EFTR). METHODS: This paper aims to perform a comprehensive review of the current literature related to supporting the underwater resection techniques with the aim to evaluate their safety and efficacy. RESULTS: Based on the current literature U-EMR appears to be feasible and safe. Comparison studies showed that U-EMR is associated with higher "en-bloc" and R0 resection rates for colonic lesions, but lower "en-bloc" and R0 resection rates for duodenal non-ampullary lesions, compared to standard EMR. In contrast to U-EMR, little evidence supporting U-ESD are currently available. A single comparison study on gastric lesions showed that U-ESD had shorter procedural times and allowed a similar "en-bloc" resection rates compared to standard ESD. No comparison studies between U-ESD and ESD are available for colonic lesions. Finally, only some anecdotal experiences have been reported for U-POEM or U-EFTR, and the feasibility and effectiveness of these techniques need to be further investigated. CONCLUSIONS: Further prospective studies are necessary to better explore the advantages of underwater techniques compared to the respective standards of care, especially in the setting of U-ESD where consistent data are lacking and where standardization of the technique is needed.
Authors: Ian D Norton; Linan Wang; Susan A Levine; Lawrence J Burgart; Erik K Hofmeister; Ashwin Rumalla; Christopher J Gostout; Bret T Petersen Journal: Gastrointest Endosc Date: 2002-07 Impact factor: 9.427
Authors: Monika Ferlitsch; Alan Moss; Cesare Hassan; Pradeep Bhandari; Jean-Marc Dumonceau; Gregorios Paspatis; Rodrigo Jover; Cord Langner; Maxime Bronzwaer; Kumanan Nalankilli; Paul Fockens; Rawi Hazzan; Ian M Gralnek; Michael Gschwantler; Elisabeth Waldmann; Philip Jeschek; Daniela Penz; Denis Heresbach; Leon Moons; Arnaud Lemmers; Konstantina Paraskeva; Juergen Pohl; Thierry Ponchon; Jaroslaw Regula; Alessandro Repici; Matthew D Rutter; Nicholas G Burgess; Michael J Bourke Journal: Endoscopy Date: 2017-02-17 Impact factor: 10.093
Authors: Felix W Leung; Judith O Harker; Guy Jackson; Kate E Okamoto; Omid M Behbahani; Nora J Jamgotchian; H Steven Aharonian; Paul H Guth; Surinder K Mann; Joseph W Leung Journal: Gastrointest Endosc Date: 2010-07-08 Impact factor: 9.427
Authors: Tonya Kaltenbach; Joseph C Anderson; Carol A Burke; Jason A Dominitz; Samir Gupta; David Lieberman; Douglas J Robertson; Aasma Shaukat; Sapna Syngal; Douglas K Rex Journal: Gastroenterology Date: 2020-02-11 Impact factor: 22.682
Authors: Paolo Cecinato; Matteo Lucarini; Chiara Campanale; Francesco Azzolini; Fabio Bassi; Romano Sassatelli Journal: Endosc Int Open Date: 2022-09-14