Colorectal polyps: underwater resection tops conventional approach

  • Yamashina T & al.
  • Gastroenterology
  • 11 abr. 2019

  • de Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Underwater endoscopic mucosal resection (UEMR) led to a greater frequency of R0 resection of 10-20-mm sessile colorectal lesions compared with conventional endoscopic mucosal resection (CEMR), with no significant difference in adverse events or procedure time.

Why this matters

  • The study is the first randomized controlled trial to compare UEMR and CEMR.

Study design

  • 211 patients with 214 polyps, at 5 institutions in Japan, were randomly assigned to UEMR or CEMR.
  • Funding: None.

Key results

  • The UEMR group had a higher R0 resection rate (69% vs 50%; P=.011) and a higher en bloc resection rate (89% vs 75%; P=.007).
  • There was no significant difference in median procedure times (165 vs 175 seconds; P=.629).
  • There were no incidents of intraprocedural hemorrhage requiring transfusion, interventional radiology, or surgery.
  • 2 patients in the CEMR group and 3 in the UEMR group experienced delayed bleeding from the treatment site within 48 hours of the procedure.
  • There were no significant differences in adverse events between the 2 groups.
  • A subset analysis showed that UEMR performed best for lesions 15 mm or higher (P=.016).

Limitations

  • Recurrence rate was not evaluated.
  • Endoscopists were not blinded.