Endoscopy 2019; 51(04): S34
DOI: 10.1055/s-0039-1681270
ESGE Days 2019 oral presentations
Friday, April 5, 2019 11:00 – 13:00: Colon: resection South Hall 2B
Georg Thieme Verlag KG Stuttgart · New York

UNDERWATER ENDOSCOPIC RESECTION FOR COLONIC LESIONS IN DIFFICULT AND CHALLENGING SITUATIONS. MULTICENTER – PRELIMINARY RESULTS

H Uchima
1   Gastrointestinal Endoscopy, Hospital Universitario Doctor Josep Trueta de Girona, Girona, Spain
2   Gastrointestinal Endoscopy, Centro Medico Teknon, Barcelona, Spain
,
J Rodriguez-Sanchez
3   Gastrointestinal Endoscopy, Hospital General Universitario Ciudad Real, Ciudad Real, Spain
,
JC Marin
4   Gastroenterology, Hospital Universitario 12 de Octubre, Digestive System Service, Madrid, Spain
,
L Torrealba
1   Gastrointestinal Endoscopy, Hospital Universitario Doctor Josep Trueta de Girona, Girona, Spain
,
M Sánchez-Alonso
3   Gastrointestinal Endoscopy, Hospital General Universitario Ciudad Real, Ciudad Real, Spain
,
D Busquets
1   Gastrointestinal Endoscopy, Hospital Universitario Doctor Josep Trueta de Girona, Girona, Spain
,
R Turro
2   Gastrointestinal Endoscopy, Centro Medico Teknon, Barcelona, Spain
,
M Albert
1   Gastrointestinal Endoscopy, Hospital Universitario Doctor Josep Trueta de Girona, Girona, Spain
,
A Mata Bilbao
2   Gastrointestinal Endoscopy, Centro Medico Teknon, Barcelona, Spain
,
JC Espinos
2   Gastrointestinal Endoscopy, Centro Medico Teknon, Barcelona, Spain
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Publikationsverlauf

Publikationsdatum:
18. März 2019 (online)

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    Aims:

    Underwater endoscopic resection (uEMR) avoids the need for submucosal injection, and it may be helpful in challenging situations such as non-lifting lesions, or difficult locations.

    The aims of the study were to assess the safety, utility and technical success rate of the underwater technique for the treatment of challenging colonic lesions.

    Methods:

    Clinical, endoscopic and histological data were collected from cases of uEMR performed in 4 centers between January 2016 and July 2018. Inclusion criteria was lesions with no-lifting sign (if a previous endoscopic injection) that were poor candidates for classic EMR, difficult location (ileocecal valve or appendix) or lesions with a previous failed attempt for EMR in an expert center.

    Results:

    60 uEMR in challenging situations were performed, of which 41 completed follow-up (mean 168 days) to date. The mean age of the patients was 66.14, being 68% men.

    There were 37 (61.67%) non-lifting lesions (including recurrent/residual lesions in ICV and appendix, and non-treated lesions), 17 (28.3%) appendicular or ileocecal valve lesions not previously treated, 1 (1.6%) intradiverticular lesion, 2 (3.3%) lesions in complex sigma and 3 (5%) residual lesion including ileocecal valve.

    The mean size (diameter) of the lesions was 19 mm, and the mean size (largest diameter) of the resection specimen was 15.3 mm (95% CI 13.68 – 16.99 mm) being the largest specimen of 30 mm in diameter. The histology showed T1 in 4 cases (one of good prognosis), HGD and intramucosal cancer in 8 cases, and no advanced histology (LGD, SSP/A withoud displasia) in the others. There were no major complications (no major bleedig nor perforations). The success of the technique was 98% with 3 recurrences, that were succesfully re-treated endoscopically.

    Conclusions:

    Underwater endoscopic resection in the colon is a safe and useful technique for challenging colorectal lesions such as non-lifting lesions, appendiceal, ileocecal valve, diverticular, and difficult sigmoid locations.


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