Endoscopy 2020; 52(S 01): S5
DOI: 10.1055/s-0040-1704022
ESGE Days 2020 oral presentations
Thursday, April 23, 2020 08:30 – 10:00 Large colonic polyps: Slice and dice Ecocem Room
© Georg Thieme Verlag KG Stuttgart · New York

PROTECTIVE ROLE OF UNDERWATER ENDOSCOPIC MUCOSAL RESECTION AGAINST THE THERMAL INJURY. A RANDOMIZED CONTROL TRIAL AND CROSS-SECTIONAL ANALYSIS

JR Sánchez
1   Hospital 12 de Octubre, Endoscopy Unit, Madrid, Spain
,
MS Alonso
2   Hospital Santa Barbara, Endoscopy Unit, Puertollano, Spain
,
AS López
3   Hospital General Universitario de Ciudad Real, Endoscopy Unit, Ciudad Real, Spain
,
DC Ugarte
4   Hospital de Cruces, Endoscopy Unit, Baracaldo, Spain
,
HI Uchima Koeklin
5   Hospital Josep Trueta, Endoscopy Unit, Gerona, Spain
,
MP Ulquiza
6   Hospital Clínic Barcelona, Endoscopy Unit, Bareclona, Spain
,
JC Marín Gabriel
1   Hospital 12 de Octubre, Endoscopy Unit, Madrid, Spain
,
J Aranda
7   Hospital Universitario Gregorio Marañon, Endoscopy Unit, Madrid, Spain
,
FR Pons
8   Hospital del Mar, Endoscopy Unit, Barcelona, Spain
,
MA Alvarez González
8   Hospital del Mar, Endoscopy Unit, Barcelona, Spain
,
L Hernández
9   Hospital Santos Reyes, Endoscopy Unit, Aranda de Duero, Spain
,
RC Macian
10   Hospital de San Pedro, Endoscopy Unit, Logroño, Spain
,
J Santiago
11   Hospital Universitario Puerta de Hierro, Endoscopy Unit, Majadahonda, Spain
,
O Patrón
12   Hospital de Manacor, Endoscopy Unit, Manacor, Spain
,
A Herreros de Tejada
11   Hospital Universitario Puerta de Hierro, Endoscopy Unit, Majadahonda, Spain
,
O Nogales
13   Hospital UNiversitario Gregorio Marañon, Endoscopy Unit, Madrid, Spain
,
E Albéniz Albizu
14   Hospital de Navarra, Endoscopy Unit, Pamplona, Spain
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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Aims Thermal injury is the corner stone of the delayed adverse events in EMR, however the strategy to downplay this fact has been scarce assessed. The role of immersion seems to be a suitable way to do it but this matter has not been tested so far.

The end-point of the study was to compare the effect of diathermy of CEMR and UEMR and its aftermath in terms of: scar appearance, safety (adverse events) and thermal artefact in histological analysis.

Methods Randomized and multicenter control trial of consecutive lesions larger than 2 cm and previously treated lesions was performed. Lesions were randomized using the REDCAP platform. A cross sectional study was done focused on technical aspects related to diathermy effect.

Results A total of 216 lesions (33,59 mm in size (10-90 mm)) were enrolled (109 in the CEMR group and 107 in the UEMR group). There was no difference in size (32.42 mm CEMR vs. 34.79 mm UEMR; p = 0,24) and location (proximal colon 63,4 % CEMR vs.57,9 % UEMR; p = 0.11). The procedures were perfomed in the same way (Piecemeal manner 57,4 % CEMR vs.59 % UEMR;p = 0.38) with equivalent snares (braided type in 82.6 % CEMR vs. 75 % UEMR; p = 0.28). Regarding the scar appearance, there were no differences in global view with Sydney ≥ 2 in 17 % CEMRvs.14 % UEMR;p = 0.58), cut vessels (12.9 % CEMR vs. 19 % UEMR; p = 0.22), however Cherry spot sign was almost three-fold higher in CEMR (27.7 %vs.10.4 %; p = 0.001), which traduced a higher delayed bleeding rate in the CEMR group (9.2 % vs.5.6 %; p = 0.23). There were no delayed perforations in both groups. Concerning the macroscopic thermal effect in the specimens, they were significantly damaged more often with CEMR (5.6 % vs.0 %; p = 0.05).

Conclusions UEMR seems to play a protective role toward diathermy damage, which gives it a better safety profile comparing to CEMR, even optimizing the quality of histological assessment.