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

G Tziatzios; P Gkolfakis; K Triantafyllou; L Fuccio; A Facciorusso; IS Papanikolaou; G Antonelli; S Nagl; A Ebigbo; A Probst; C Hassan; M Pellise; H Messmann

doi:10.1055/s-0041-1724719

Endoscopy, Table of Contents

Endoscopy 2021; 53(S 01): S171-S172
DOI: 10.1055/s-0041-1724719

Abstracts | ESGE Days

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

G Tziatzios

¹Propaedeutic, Medical School, National and Kapodistrian University of Athens, ‘‘Attikon” University General Hospital, Hepatogastroenterology Unit, Second Department of Internal Medicine, Athens, Greece

,

P Gkolfakis

²Erasme University Hospital, Université Libre de Bruxelles, Department of Gastroenterology Hepatopancreatology and Digestive Oncology, Brussels, Belgium

,

K Triantafyllou

¹Propaedeutic, Medical School, National and Kapodistrian University of Athens, ‘‘Attikon” University General Hospital, Hepatogastroenterology Unit, Second Department of Internal Medicine, Athens, Greece

,

L Fuccio

³S. Orsola-Malpighi Hospital, Gastroenterology Unit, Department of Medical and Surgical Sciences, Bologna, Italy

,

A Facciorusso

⁴University of Foggia, Gastroenterology Unit, Department of Surgical and Medical Sciences, Foggia, Italy

,

IS Papanikolaou

¹Propaedeutic, Medical School, National and Kapodistrian University of Athens, ‘‘Attikon” University General Hospital, Hepatogastroenterology Unit, Second Department of Internal Medicine, Athens, Greece

,

G Antonelli

⁵Nuovo Regina Margherita Hospital, Gastroenterology Unit, Rome, Italy

,

S Nagl

⁶University Hospital Augsburg, Department of Gastroenterology, Augsburg, Germany

,

A Ebigbo

⁶University Hospital Augsburg, Department of Gastroenterology, Augsburg, Germany

,

A Probst

⁶University Hospital Augsburg, Department of Gastroenterology, Augsburg, Germany

,

C Hassan

⁵Nuovo Regina Margherita Hospital, Gastroenterology Unit, Rome, Italy

,

M Pellise

⁷Hospital Clínic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Gastroenterology Department, Barcelona, Spain

,

H Messmann

⁶University Hospital Augsburg, Department of Gastroenterology, Augsburg, Germany

› Author Affiliations

Abstract

Full Text

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.