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Endoscopy
DOI: 10.1055/a-2479-9227
Innovations and brief communications

Procedural outcomes of a novel underwater injection endoscopic mucosal resection technique for colorectal polyps ≥10 mm

Yuichiro Hirai
1   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan (Ringgold ID: RIN68380)
,
Naoya Toyoshima
1   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan (Ringgold ID: RIN68380)
,
Hiroyuki Takamaru 
1   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan (Ringgold ID: RIN68380)
,
Masau Sekiguchi 
1   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan (Ringgold ID: RIN68380)
2   Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan (Ringgold ID: RIN68380)
,
Masayoshi Yamada 
1   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan (Ringgold ID: RIN68380)
,
Nozomu Kobayashi
1   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan (Ringgold ID: RIN68380)
2   Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan (Ringgold ID: RIN68380)
,
Shigeki Sekine
3   Division of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan (Ringgold ID: RIN68380)
,
Yutaka Saito
1   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan (Ringgold ID: RIN68380)
› Author AffiliationsSupported by: This work was supported in part by the National Cancer Center Research and Development Fund (2023-A-15).
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Abstract

Background

It is uncertain whether underwater endoscopic mucosal resection (UEMR) enables resection of the submucosal tissue with sufficient margins for T1 colorectal cancer (CRC) because UEMR forgoes submucosal injection. Therefore, we developed a novel “underwater injection EMR” (UIEMR) method that combines submucosal injection with UEMR to obtain an adequate vertical margin.

Methods

We retrospectively analyzed procedure-related outcomes of 135 consecutive lesions from patients who underwent UIEMR for ≥10-mm nonpedunculated colorectal polyps (median size 15 mm). The outcomes included the en bloc, R0, RX, and R1 resection rates, and adverse events. Additionally, the vertical margin distance of seven T1 CRCs was evaluated.

Results

En bloc resection was achieved in 127 lesions (94.1%). R0 and RX resections were observed in 92 (68.1%) and 42 lesions (31.1%), respectively, while R1 resection was seen in only one lesion (0.7%). There were two cases with adverse events (1.5%), both delayed bleeding. In T1 CRCs, all seven cases had free vertical margins, and the median vertical margin distance was 1140 µm (range 731–1570 µm).

Conclusions

UIEMR safely demonstrated high success rates for en bloc resection, and potentially ensures a sufficient vertical margin. This technique might be an option, particularly for relatively small lesions concerning for T1 CRC, and deserves further study.

Supplementary Material



Publication History

Received: 22 March 2024

Accepted after revision: 20 November 2024

Accepted Manuscript online:
20 November 2024

Article published online:
28 January 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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