Year 2023 / Volume 115 / Number 5
Original
Underwater versus conventional endoscopic mucosal resection for sessile colorectal polyps: an updated systematic review and meta-analysis

225-233

DOI: 10.17235/reed.2022.8956/2022

Sridhar Sundaram, Vishal Seth, Vaneet Jearth, Suprabhat Giri,

Abstract
Background: underwater endoscopic mucosal resection (uEMR) without submucosal injection for sessile colorectal polyps was introduced as a new replacement for conventional EMR (cEMR). However, the optimal resection strategy remains a topic of debate. Hence, this meta-analysis was performed to compare the efficacy and safety of uEMR and cEMR in patients with sessile colorectal polyps. Methods: a comprehensive search of the literature from 2000 till January 2022 was performed from Medline, CENTRAL and Embase for randomized controlled trials (RCTs) comparing cEMR vs uEMR for colorectal polyps. The evaluated outcomes included en bloc resection, R0 resection, procedure time, overall bleeding and recurrence. Pooled risk ratios (RR) with 95 % confidence interval were calculated using a random effect model. Results: six studies were included, out of which four were full-text articles and two were conference abstracts. En bloc resection (RR 1.26, 95 % CI: 1.00-1.60), R0 resection (RR 1.10, 95 % CI: 0.96-1.26), overall bleeding (RR 0.85, 95 % CI: 0.54-1.34) and recurrence rate (RR 0.75, 95 % CI: 0.45-1.27) were comparable between uEMR and cEMR. However, uEMR was associated with a shorter procedure time (mean difference [MD] -1.55 minutes, 95 % CI: -2.71 to -0.39). According to the subgroup analysis, uEMR led to a higher rate of en bloc resection (RR 1.41, 95 % CI: 1.07-1.86) and R0 resection (RR 1.19, 95 % CI: 1.01-1.41) for polyps ≥ 10 mm in size. Conclusion: both uEMR and cEMR have a comparable safety and efficacy. For polyps larger than 10 mm, uEMR may have an advantage over cEMR and should be the topic for future studies.
Lay Summary
Endoscopic mucosal resection is a minimally invasive alternative to surgery for removing polyps from the colon. The conventional EMR (cEMR) involves injection of a lifting agent under the polyp followed by cutting, compared to underwater endoscopic mucosal resection (uEMR) in which cutting is done underwater, without injection. Hence, this meta-analysis was conducted to compare the efficacy and safety of uEMR and cEMR in patients with sessile colorectal polyps. There was no difference between the two techniques concerning the removal of the entirety of a tumor without violating its capsule and microscopically margin-negative resection. Also, the overall rate of bleeding and recurrence of polyp were comparable between the groups. However, uEMR was associated with a shorter procedural duration. On subgroup analysis of polyps with size ≥ 10 mm, uEMR was better in terms of removal of the entirety of a tumor without violating its capsule and microscopically negative resection margin. To conclude, both uEMR and cEMR have comparable safety and efficacy. For polyps larger than 10 mm, uEMR may have an advantage over cEMR and should be the topic for future studies.
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Sundaram S, Seth V, Jearth V, Giri S. Underwater versus conventional endoscopic mucosal resection for sessile colorectal polyps: an updated systematic review and meta-analysis. 8956/2022


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Publication history

Received: 24/05/2022

Accepted: 06/09/2022

Online First: 23/09/2022

Published: 05/05/2023

Article revision time: 98 days

Article Online First time: 122 days

Article editing time: 346 days


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