The efficacy and safety of underwater endoscopic mucosal resection for ≥10-mm colorectal polyps: systematic review and meta-analysis

De-feng Li; Ming-Guang Lai; Mei-feng Yang; Zhi-yuan Zou; Jing Xu; Ru-mei Peng; Feng Xiong; Cheng Wei; Ding-guo Zhang; Zheng-lei Xu; Li-sheng Wang; Jun Yao

doi:10.1055/a-1234-8918

Endoscopy, Table of Contents

Endoscopy 2021; 53(06): 636-646
DOI: 10.1055/a-1234-8918

Systematic review

The efficacy and safety of underwater endoscopic mucosal resection for ≥10-mm colorectal polyps: systematic review and meta-analysis

De-feng Li

¹Department of Gastroenterology, Shenzhen Peopleʼs Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China

,

Ming-Guang Lai

¹Department of Gastroenterology, Shenzhen Peopleʼs Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China

,

Mei-feng Yang

²Department of Hematology, Yantian District People's Hospital, Shenzhen, Guangdong, China

,

Zhi-yuan Zou

¹Department of Gastroenterology, Shenzhen Peopleʼs Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China

,

Jing Xu

³Department of Gastroenterology and Hepatology, Guangzhou Digestive Disease Center, Guangzhou First People's Hospital, Guangzhou, Guangdong, China

,

Ru-mei Peng

⁴Department of Gastroenterology, The First Affiliated Hospital of University of South China, University of South China, Hengyang, Hunan, China

,

Feng Xiong

¹Department of Gastroenterology, Shenzhen Peopleʼs Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China

,

Cheng Wei

¹Department of Gastroenterology, Shenzhen Peopleʼs Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China

,

Ding-guo Zhang

¹Department of Gastroenterology, Shenzhen Peopleʼs Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China

,

Zheng-lei Xu

¹Department of Gastroenterology, Shenzhen Peopleʼs Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China

,

Li-sheng Wang

¹Department of Gastroenterology, Shenzhen Peopleʼs Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China

,

Jun Yao

¹Department of Gastroenterology, Shenzhen Peopleʼs Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China

› Author Affiliations

Abstract

Background Underwater endoscopic mucosal resection (UEMR) is a promising strategy for nonpedunculated colorectal polyp removal. However, the efficacy and safety of the technique for the treatment of ≥ 10-mm colorectal polyps remain unclear. We aimed to comprehensively assess the efficacy and safety of UEMR for polyps sized 10–19 mm and ≥ 20 mm.

Methods PubMed, EMBASE, and the Cochrane Library databases were searched for relevant articles from January 2012 to November 2019. Primary outcomes were the rates of adverse events and residual polyps. Secondary outcomes were the complete resection, en bloc resection, and R0 resection rates.

Results 18 articles including 1142 polyps from 1093 patients met our inclusion criteria. The overall adverse event and residual polyp rates were slightly lower for UEMR when removing colorectal polyps of 10–19 mm vs. ≥ 20 mm (3.5 % vs. 4.3 % and 1.2 % vs. 2.6 %, respectively). The UEMR-related complete resection rate was slightly higher for colorectal polyps of 10–19 mm vs. ≥ 20 mm (97.9 % vs. 92.0 %). However, the en bloc and R0 resection rates were dramatically higher for UEMR removal of polyps of 10–19 mm vs. ≥ 20 mm (83.4 % vs. 36.1 % and 73.0 % vs. 40.0 %, respectively). In addition, univariate meta-regression revealed that polyp size was an independent predictor for complete resection rate (P = 0.03) and en bloc resection (P = 0.01).

Conclusions UEMR was an effective and safe technique for the removal of ≥ 10-mm nonpedunculated colorectal polyps. However, UEMR exhibited low en bloc and R0 resection rates for the treatment of ≥ 20-mm polyps.

Full Text

References

References
1 Bray F, Ferlay J, Soerjomataram I. et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68: 394-424
2 Zauber AG, Winawer SJ, OʼBrien MJ. et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. NEJM 2012; 366: 687-696
3 Kandel P, Wallace MB. Colorectal endoscopic mucosal resection (EMR). Best Pract Res Clin Gastroenterol 2017; 31: 455-471
4 Hwang JH, Konda V. ASGE Technology Committee. et al. Endoscopic mucosal resection. Gastrointest Endosc 2015; 82: 215-226
5 Nelson DB. Techniques for difficult polypectomy. MedGenMed 2004; 6: 12-20
6 Hurlstone DP, Sanders DS, Cross SS. et al. Colonoscopic resection of lateral spreading tumours: a prospective analysis of endoscopic mucosal resection. Gut 2004; 53: 1334-1339
7 Hotta K, Fujii T, Saito Y. et al. Local recurrence after endoscopic resection of colorectal tumors. Int J Colorectal Dis 2009; 24: 225-230
8 Binmoeller KF, Weilert F, Shah J. et al. "Underwater" EMR without submucosal injection for large sessile colorectal polyps (with video). Gastrointest Endosc 2012; 75: 1086-1091
9 Yamashina T, Uedo N, Akasaka T. et al. Comparison of underwater vs conventional endoscopic mucosal resection of intermediate-size colorectal polyps. Gastroenterology 2019; 157: 451-461
10 Yen AW, Leung JW, Wilson MD. et al. Underwater versus conventional endoscopic resection of nondiminutive nonpedunculated colorectal lesions: a prospective randomized controlled trial (with video). Gastrointest Endosc 2020; 91: 643-654
11 Cadoni S, Liggi M, Gallittu P. et al. Underwater endoscopic colorectal polyp resection: Feasibility in everyday clinical practice. United European Gastroenterol J 2018; 6: 454-462
12 Rodriguez Sanchez J, Uchima Koecklin H, Gonzalez Lopez L. et al. Short and long-term outcomes of underwater EMR compared to the traditional procedure in the real clinical practice. Rev Esp Enferm Dig 2019; 111: 543-549
13 Spadaccini M, Fuccio L, Lamonaca L. et al. Underwater EMR for colorectal lesions: a systematic review with meta-analysis (with video). Gastrointest Endosc 2019; 89: 1109-1116.e1104
14 Knabe M, Pohl J, Gerges C. et al. Standardized long-term follow-up after endoscopic resection of large, nonpedunculated colorectal lesions: a prospective two-center study. Am J Gastroenterol 2014; 109: 183-189
15 Oka S, Tanaka S, Saito Y. et al. Local recurrence after endoscopic resection for large colorectal neoplasia: a multicenter prospective study in Japan. Am J Gastroenterol 2015; 110: 697-707
16 Stroup DF, Berlin JA, Morton SC. et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000; 283: 2008-2012
17 Jadad AR, Moore RA, Carroll D. et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Control Clin Trials 1996; 17: 1-12
18 Liberati A, Altman DG, Tetzlaff J. et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med 2009; 151: W65-W94
19 Burgess NG, Bahin FF, Bourke MJ. Colonic polypectomy (with videos). Gastrointest Endosc 2015; 81: 813-835
20 Sandhu DS, Lee YJ, Gerke H. Underwater endoscopic mucosal resection: an alternative treatment for large colorectal polyp removal. Minerva Gastroenterol Dietol 2018; 64: 106-110
21 Schenck RJ, Jahann DA, Patrie JT. et al. Underwater endoscopic mucosal resection is associated with fewer recurrences and earlier curative resections compared to conventional endoscopic mucosal resection for large colorectal polyps. Surg Endosc 2017; 31: 4174-4183
22 Binmoeller KF, Hamerski CM, Shah JN. et al. Underwater EMR of adenomas of the appendiceal orifice (with video). Gastrointest Endosc 2016; 83: 638-642
23 Binmoeller KF, Hamerski CM, Shah JN. et al. Attempted underwater en bloc resection for large (2-4 cm) colorectal laterally spreading tumors (with video). Gastrointest Endosc 2015; 81: 713-718
24 Wang AY, Flynn MM, Patrie JT. et al. Underwater endoscopic mucosal resection of colorectal neoplasia is easily learned, efficacious, and safe. Surg Endosc 2014; 28: 1348-1354
25 Kim HG, Thosani N, Banerjee S. et al. Underwater endoscopic mucosal resection for recurrences after previous piecemeal resection of colorectal polyps (with video). Gastrointest Endosc 2014; 80: 1094-1102
26 Chaves DM, Brito HP, Chaves LT. et al. Underwater endoscopic mucosal resection of serrated adenomas. Clinics (Sao Paulo) 2018; 73: e339
27 Siau K, Ishaq S, Cadoni S. et al. Feasibility and outcomes of underwater endoscopic mucosal resection for ≥ 10 mm colorectal polyps. Surg Endosc 2018; 32: 2656-2663
28 Amato A, Radaelli F, Spinzi G. Underwater endoscopic mucosal resection: The third way for en bloc resection of colonic lesions?. United European Gastroenterol J 2016; 4: 595-598
29 Curcio G, Granata A, Ligresti D. et al. Underwater colorectal EMR: remodeling endoscopic mucosal resection. Gastrointest Endosc 2015; 81: 1238-1242
30 Uedo N, Nemeth A, Johansson GW. et al. Underwater endoscopic mucosal resection of large colorectal lesions. Endoscopy 2015; 47: 172-174
31 Chien HC, Uedo N, Hsieh PH. Comparison of underwater and conventional endoscopic mucosal resection for removing sessile colorectal polyps: a propensity-score matched cohort study. Endosc Int Open 2019; 7: E1528-E1536
32 Kawamura T, Sakai H, Ogawa T. et al. Feasibility of underwater endoscopic mucosal resection for colorectal lesions: a single center study in Japan. Gastroenterology Res 2018; 11: 274-279
33 Moss A, Bourke MJ, Williams SJ. et al. Endoscopic mucosal resection outcomes and prediction of submucosal cancer from advanced colonic mucosal neoplasia. Gastroenterology 2011; 140: 1909-1918
34 Heldwein W, Dollhopf M, Rosch T. et al. The Munich Polypectomy Study (MUPS): prospective analysis of complications and risk factors in 4000 colonic snare polypectomies. Endoscopy 2005; 37: 1116-1122
35 Mannath J, Subramanian V, Singh R. et al. Polyp recurrence after endoscopic mucosal resection of sessile and flat colonic adenomas. Dig Dis Sci 2011; 56: 2389-2395

Supplementary Material

Supplementary material