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Underwater Endoscopic Mucosal Resection for 10 mm or Larger Nonpedunculated Colorectal Polyps: A Systematic Review and Meta-Analysis

Babu P. Mohan|Amandeep Singh|Tarun Rustagi|Rajat Garg|Manik Aggarwal|Jaideep Bhalla|Carol Burke|Prabhleen Chahal
대한소화기내시경학회 (The Korean Society Of Gastrointestinal Endoscopy)|2021.05|Clinical Endoscopy|제54권 제3호|pp. 379-389|DOI 10.5946/ce.2020.276

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EMRUnderwaterPolypsResectionColorectal
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초록

Background/Aims: Recent studies have reported the favorable outcomes of underwater endoscopic mucosal resection (UEMR)for colorectal polyps. We performed a systematic review and meta-analysis evaluating the efficacy and safety of UEMR fornonpedunculated polyps ≥10 mm. Methods: We performed a comprehensive search of multiple databases (through May 2020) to identify studies reporting theoutcomes of UEMR for ≥10 mm nonpedunculated colorectal polyps. The assessed outcomes were recurrence rate on the first followup,en bloc resection, incomplete resection, and adverse events after UEMR. Results: A total of 1276 polyps from 16 articles were included in our study. The recurrence rate was 7.3% (95% confidence interval[CI], 4.3–12) and 5.9% (95% CI, 3.6–9.4) for nonpedunculated polyps ≥10 and ≥20 mm, respectively. For nonpedunculated polyps≥10 mm, the en bloc resection, R0 resection, and incomplete resection rates were 57.7% (95% CI, 42.4–71.6), 58.9% (95% CI, 42.4–73.6), and 1.5% (95% CI, 0.8–2.6), respectively. The rates of pooled adverse events, intraprocedural bleeding, and delayed bleedingwere 7.0%, 5.4%, and 2.9%, respectively. The rate of perforation and postpolypectomy syndrome was 0.8%. Conclusions: Our systematic review and meta-analysis demonstrates that UEMR for nonpedunculated colorectal polyps ≥10 mm issafe and effective with a low rate of recurrence.

Abstract

Background/Aims: Recent studies have reported the favorable outcomes of underwater endoscopic mucosal resection (UEMR)for colorectal polyps. We performed a systematic review and meta-analysis evaluating the efficacy and safety of UEMR fornonpedunculated polyps ≥10 mm. Methods: We performed a comprehensive search of multiple databases (through May 2020) to identify studies reporting theoutcomes of UEMR for ≥10 mm nonpedunculated colorectal polyps. The assessed outcomes were recurrence rate on the first followup,en bloc resection, incomplete resection, and adverse events after UEMR. Results: A total of 1276 polyps from 16 articles were included in our study. The recurrence rate was 7.3% (95% confidence interval[CI], 4.3–12) and 5.9% (95% CI, 3.6–9.4) for nonpedunculated polyps ≥10 and ≥20 mm, respectively. For nonpedunculated polyps≥10 mm, the en bloc resection, R0 resection, and incomplete resection rates were 57.7% (95% CI, 42.4–71.6), 58.9% (95% CI, 42.4–73.6), and 1.5% (95% CI, 0.8–2.6), respectively. The rates of pooled adverse events, intraprocedural bleeding, and delayed bleedingwere 7.0%, 5.4%, and 2.9%, respectively. The rate of perforation and postpolypectomy syndrome was 0.8%. Conclusions: Our systematic review and meta-analysis demonstrates that UEMR for nonpedunculated colorectal polyps ≥10 mm issafe and effective with a low rate of recurrence.

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