Underwater Versus Conventional Endoscopic Mucosal Resection for Treating Colorectal Polyps: A Systematic Review and Meta-Analysis of Randomized Controlled Studies

Aims Previous meta-analysis including nonrandomized studies showed marginal benefit of underwater endoscopic mucosal resection (U-EMR) compared to conventional EMR (C-EMR) in terms of polypectomy outcomes. We evaluated the effectiveness and safety of U-EMR compared to C-EMR in the treatment of colorectal polyps by including only randomized controlled trials (RCTs).

Methods PubMed and Cochrane Library databases were searched for RCTs published until 10/2020, evaluating U-EMR vs. C-EMR in terms of en bloc resection, complete resection, post-endoscopic resection adenoma recurrence, adverse events rates and difference in resection time. Abstracts from Digestive Disease Week, United European Gastroenterology Week and ESGE Days meetings were also searched. The effect size on study outcomes is presented as the risk ratio (RR; 95 % confidence interval [CI]) or mean difference (MD; 95 %CI). Heterogeneity was quantified using the I² test. We also assessed the strength of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Results Six RCTs analyzing outcomes from 1501 colorectal polyps (U-EMR, 769; C-EMR, 732) were included. U-EMR was associated with significant increase rate of en bloc resection compared to C-EMR [RR (95 %CI): 1.20 (1.01-1.44); Ι²=87 %, GRADE: Low], with subgroup analysis showing that U-EMR is particularly beneficial when treating polyps sized ≥20mm compared to polyps <20mm [RR (95 %CI): 1.64 (1.22-2.20); Ι²=23 % versus 1.05 (0.96-1.16); Ι²=69 %]. In contrast, no statistically significant difference between U-EMR and C-EMR regarding complete resection [RR (95 %CI): 1.07 (0.92-1.25); Ι²=89 %, GRADE: Low], post- resection recurrence [RR (95 %CI): 0.58 (0.34-1.00); Ι²=0 %, GRADE: Low] and adverse events [RR (95 %CI): 0.97 (0.69-1.37); Ι²=0 %, GRADE: Low] was evident.

Conclusions Meta-analysis of RCTs supports that underwater endoscopic mucosal resection leads to higher rate of en bloc resection compared to conventional EMR. This effect is driven by the significant difference of the two techniques when treating large (≥20mm) polyps.

Citation: Tziatzios G, Gkolfakis P, Triantafyllou K et al. eP223 UNDERWATER VERSUS CONVENTIONAL ENDOSCOPIC MUCOSAL RESECTION FOR TREATING COLORECTAL POLYPS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED STUDIES. Endoscopy 2021; 53: S171.

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Artikel online veröffentlicht:
19. März 2021