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CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(12): E1884-E1894
DOI: 10.1055/a-1287-9621
Review

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

Rajat Garg
1   Department of Hospital Medicine, Cleveland Clinic, Ohio, United States
,
Amandeep Singh
2   Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute; Cleveland Clinic, Cleveland, Ohio, United States
,
Babu P. Mohan
3   Department of Inpatient Medicine, University of Arizona, Banner University Medical Center, Tucson, Arizona, United States
,
Gautam Mankaney
2   Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute; Cleveland Clinic, Cleveland, Ohio, United States
,
Miguel Regueiro
2   Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute; Cleveland Clinic, Cleveland, Ohio, United States
,
Prabhleen Chahal
2   Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute; Cleveland Clinic, Cleveland, Ohio, United States
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Abstract

Background and study aims Underwater endoscopic mucosal resection (UEMR) for colorectal polyps has been reported to have good outcomes in recent studies. We conducted a systematic review and meta-analysis comparing the effectiveness and safety of UEMR to conventional EMR (CEMR).

Methods A comprehensive search of multiple databases (through May 2020) was performed to identify studies that reported outcome of UEMR and CEMR for colorectal lesions. Outcomes assessed included incomplete resection, rate of recurrence, en bloc resection, adverse events (AEs) for UEMR and CEMR.

Results A total of 1,651 patients with 1,704 polyps were included from nine studies. There was a significantly lower rate of incomplete resection (odds ratio [OR]: 0.19 (95 % confidence interval (CI), 0.05–0.78, P = 0.02) and polyp recurrence (OR: 0.41, 95 % CI, 0.24–0.72, P = 0.002) after UEMR. Compared to CEMR, rates overall complications (relative risk [RR]: 0.66 (95 % CI, 0.48–0.90) (P = 0.008), and intra-procedural bleeding (RR: 0.59, 95 % CI, 0.41–0.84, P = 0.004) were significantly lower with UEMR. The recurrence rate was also lower for large non-pedunculated polyps ≥ 10 mm (OR 0.24, 95 % CI, 0.10–0.57, P = 0.001) and ≥ 20 mm (OR 0.14, 95 % CI, 0.02–0.72, P = 0.01). The rates of en bloc resection, delayed bleeding, perforation and post-polypectomy syndrome were similar in both groups (P > 0.05).

Conclusions In this systematic review and meta-analysis, we found that UEMR is more effective and safer than CEMR with lower rates of recurrence and AEs. UEMR use should be encouraged over CEMR.

Supplementary material



Publication History

Received: 24 June 2020

Accepted: 21 September 2020

Article published online:
27 November 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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