Underwater versus conventional endoscopic mucosal resection for colorectal lesions: An updated meta-analysis of randomized controlled trials

Aneesa Rahman Chowdhury; Jin Sun Kim; Mimi Xu; Chloe Tom; Rachan Narala; Niwen Kong; Helen Lee; Alejandro Vazquez; Ara Sahakian; Jennifer Phan; James Buxbaum

doi:10.1055/a-2150-9899

Endoscopy International Open, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Endosc Int Open 2023; 11(10): E935-E942
DOI: 10.1055/a-2150-9899

Review

Underwater versus conventional endoscopic mucosal resection for colorectal lesions: An updated meta-analysis of randomized controlled trials

Aneesa Rahman Chowdhury

¹Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, United States

,

Jin Sun Kim

¹Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, United States

,

Mimi Xu

¹Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, United States

,

Chloe Tom

¹Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, United States

,

Rachan Narala

¹Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, United States

,

Niwen Kong

¹Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, United States

,

Helen Lee

¹Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, United States

,

Alejandro Vazquez

¹Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, United States

,

Ara Sahakian

¹Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, United States

,

Jennifer Phan

¹Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, United States

,

James Buxbaum

¹Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, United States

› Institutsangaben

Abstract

Background and study aims Colorectal malignancy is a leading cause of death. Conventional endoscopic mucosal resection (CEMR) is a strategy used to resect precancerous lesions that involves injecting fluid beneath a polyp to create a gap for resection. Underwater endoscopic mucosal resection (UEMR) is a newer method that forgoes injection, instead filling the intestinal cavity with water to facilitate polyp resection. Our aim was to compare the safety and efficacy of these approaches by synthesizing the most contemporary evidence.

Methods PubMed, Embase, and Cochrane libraries were searched from inception through November 11, 2022 for randomized controlled trials (RCTs) comparing UEMR and CEMR for resection of colorectal lesions. The primary outcome was the rate of en bloc resection and secondary outcomes included recurrence, procedure time, and adverse events (AEs).

Results A total of 2539 studies were identified through our systematic literature search. After screening, seven RCTs with a total of 1581 polyps were included. UEMR was associated with significantly increased rates of en bloc resection (RR 1.18 [1.03, 1.35]; I² = 76.6%) versus conventional approaches. No significant differences were found in procedure time, recurrence, or AEs.

Conclusions UEMR is a promising effective technique for removal of colorectal lesions. The most contemporary literature indicates that it improves en bloc resection rate without increasing procedure time, recurrence, or AEs (PROSPERO ID CRD42022374935).

Keywords

Polyps / adenomas / ... - Endoscopy Lower GI Tract - Endoscopic resection (polypectomy, ESD, EMRc, ...) - Colorectal cancer

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