Commentary

Innovative endoscopic techniques are attracting increasing attention as an alternative to surgery for early-stage colorectal cancer. One such alternative is endoscopic mucosal resection after endoscopic ultrasound (EUS).

In this video, Akahoshi et al. show the successful removal of a 7-mm, pT1b colorectal cancer (CRC) in the cecum using underwater endoscopic mucosal resection (UEMR) following EUS. However, before this technique can be considered for routine clinical practice, it must be further analyzed for efficacy, safety, and practicality.

Previous studies have shown that R0 resection rates for pT1b CRCs are lower using UEMR (40 %) [1] compared to endoscopic submucosal dissection (ESD) (65 %) [2] or endoscopic full-thickness resection (EFTR) (83 %) [3]. In addition, there is little available research on the safety of UEMR procedures. Finally, although UEMR may seem like a relatively simple procedure compared to ESD and EFTR, the technical challenge and difficulty of image interpretation when performing EUS should not be underestimated.

Publication History

Article published online:
20 December 2022

• References

• 1 Fukuda H, Takeuchi Y, Shoji A. et al. Curative value of underwater endoscopic mucosal resection for submucosally invasive colorectal cancer. J Gastroenterol Hepatol 2021; 36: 2471-2478
• 2 Watanabe D, Toyonaga T, Ooi M. et al. Clinical outcomes of deep invasive submucosal colorectal cancer after ESD. Surg Endosc 2018; 32: 2123-2130
• 3 Dolan RD, Bazarbashi AN, McCarty TR. et al. Endoscopic full-thickness resection of colorectal lesions: a systematic review and meta-analysis. Gastrointest Endosc 2022; 95: 216-224.e18