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CC BY-NC-ND 4.0 · Endoscopy
DOI: 10.1055/a-2445-4970
Innovations and brief communications

Prospective randomized trial comparing conventional and underwater endoscopic submucosal dissection for superficial colorectal neoplasms

Mitsuru Nagata 
1   Endoscopy, Shonan Fujisawa Tokushukai Hospital, Fujisawa, Japan (Ringgold ID: RIN370772)
,
Masayuki Namiki
2   Center for Digestive and Hepato-Biliary-Pancreatic Disease, Shonan Fujisawa Tokushukai Hospital, Fujisawa, Japan (Ringgold ID: RIN370772)
,
Tomoaki Fujikawa
2   Center for Digestive and Hepato-Biliary-Pancreatic Disease, Shonan Fujisawa Tokushukai Hospital, Fujisawa, Japan (Ringgold ID: RIN370772)
,
Hiromi Munakata
2   Center for Digestive and Hepato-Biliary-Pancreatic Disease, Shonan Fujisawa Tokushukai Hospital, Fujisawa, Japan (Ringgold ID: RIN370772)
› Author Affiliations Clinical Trial: Registration number (trial ID): UMIN000038529, Trial registry: UMIN Japan (http://www.umin.ac.jp/english/), Type of Study: Prospective, Randomized, Single-Center Study
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Deep dive into water-aided colonoscopy – underwater techniques without a splashEndoscopy eFirst
DOI: 10.1055/a-2496-6379

Abstract

Background and study aims This study compared procedure-related outcomes of conventional and underwater endoscopic submucosal dissection (ESD) for superficial colorectal neoplasms (SCNs).

Patients and methods In this single-center, randomized controlled trial, patients with SCNs meeting the indications of the Japanese guidelines for ESD were randomly assigned to undergo conventional ESD (CESD) or underwater ESD (UESD) performed by an expert. The primary endpoint was dissection speed, defined as the specimen area per ESD time.

Results We analyzed the data of 69 and 70 CESD and UESD cases, respectively; however, no significant differences were found in median dissection speed (17.4 and 19.9 mm2/min, respectively; P=0.19). Multiple regression analysis revealed that the suitable positional relationship between the lesion and the direction of gravity (nongravity side for CESD and gravity side for UESD) was independently and positively associated with dissection speed (P<0.001). En bloc resection was achieved without perforation in all cases. The incidence of post-ESD coagulation syndrome was not significantly different between the two groups (4.3% vs. 2.9%, respectively; P=0.68).

Conclusions UESD did not expedite dissection speed in the overall patient population. CESD and UESD may be complementary in the colorectum depending on the positional relationship between the lesion and the direction of gravity.

Supplementary Material



Publication History

Received: 13 June 2024

Accepted after revision: 17 October 2024

Accepted Manuscript online:
18 October 2024

Article published online:
26 November 2024

© 2024. 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 commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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