Año 2019 / Volumen 111 / Número 7
Original
Short and long-term outcomes of underwater EMR compared to the traditional procedure in the real clinical practice

543-549

DOI: 10.17235/reed.2019.6009/2018

Joaquín Rodríguez Sánchez, Hugo Uchima Koecklin, Lucía González López, Miriam Cuatrecasas, Eva de la Santa Belda, Pilar Olivencia Palomar, Carlos Sánchez García, Mónica Sánchez Alonso, José Ramón Muñoz Rodríguez, Francisco Javier Gómez Romero, Bartolomé López Viedma, Ana Belén Agarrabeitia, José Olmedo Camacho, Eduardo Albéniz Arbizu,

Resumen
Background and aims: underwater endoscopic mucosal resection (U-EMR) has been recently described as an alternative to endoscopic mucosal resection (EMR) for flat colorectal polyps. However, the real applications remain unclear due to the lack of comparative studies. Methods: a multi-centric prospective study was performed from November 2016 to December 2017. All lesions larger than 15 mm that were resected with both techniques were included in the study. The samples were matched using the size, morphology, site and access (SMSA) score as a reference. The efficacy, efficiency and adverse events rates were compared. Results: a total of 162 resections were collected (112 EMR and 50 U-EMR) with an average size of 25 mm. U-EMR achieved better results for the en bloc resection rate (49 vs 62%; p = 0.08) and there were no cases of an incomplete resection (10.7 vs 0%; p = 0.01). U-EMR was faster than EMR and there were no differences in the adverse events rate. Furthermore, U-EMR tended to achieve better results in terms of recurrence. Performing the resection in emersion appeared to prevent the cautery artefact, especially in sessile serrated adenomas. Conclusion: in the real clinical practice, U-EMR and EMR are equivalent in terms of efficacy and safety. Furthermore, U-EMR may be a feasible approach to prevent cautery artefact, allowing an accurate pathologic assessment.
Share Button
Nuevo comentario
Comentarios
No hay comentarios para este artículo.
Bibliografía
1. Ferlitsch M, Moss A, Hassan C, et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2017;49:270-297.
2. Moss A, Williams SJ, Hourigan LF, et al. Long-term adenoma recurrence following wide-field endoscopic mucosal resection (WF-EMR) for advanced colonic mucosal neoplasia is infrequent: results and risk factors in 1000 cases from the Australian Colonic EMR (ACE) study. Gut 2015;64:57-65.
3. Tate DJ, Awadie H, Bahin FF, et al. Wide-field piecemeal cold snare polypectomy of large sessile serrated polyps without a submucosal injection is safe. Endoscopy 2018;50:248-252.
4. Binmoeller KF, Weilert F, Shah J, et al. "Underwater" EMR without submucosal injection for large sessile colorectal polyps (with video). Gastrointest Endosc 2012;75:1086-91.
5. Binmoeller KF, Hamerski CM, Shah JN, et al. Underwater EMR of adenomas of the appendiceal orifice (with video). Gastrointest Endosc 2016;83:638-42.
6. Binmoeller KF, Hamerski CM, Shah JN, et al. Attempted underwater en bloc resection for large (2-4 cm) colorectal laterally spreading tumors (with video). Gastrointest Endosc 2015;81:713-8.
7. Sidhu M, Tate DJ, Desomer L, et al. The size, morphology, site, and access score predicts critical outcomes of endoscopic mucosal resection in the colon. Endoscopy 2018.
8. Schenck RJ, Jahann DA, Patrie JT, et al. Underwater endoscopic mucosal resection is associated with fewer recurrences and earlier curative resections compared to conventional endoscopic mucosal resection for large colorectal polyps. Surg Endosc 2017.
9. Kim HG, Thosani N, Banerjee S, et al. Underwater endoscopic mucosal resection for recurrences after previous piecemeal resection of colorectal polyps (with video). Gastrointest Endosc 2014;80:1094-102.
10. Takeuchi Y, Tonai Y, Ikeda K. Underwater endoscopic mucosal resection for a superficial polyp located at the anastomosis after surgical colectomy. Dig Endosc 2017;29 Suppl 2:67-68.
11. Ponugoti PL, Rex DK. Perforation during underwater EMR. Gastrointest Endosc 2016;84:543-4.
12. Curcio G, Granata A, Ligresti D, et al. Underwater colorectal EMR: remodeling endoscopic mucosal resection. Gastrointest Endosc 2015;81:1238-42.
13. Amato A, Radaelli F, Spinzi G. Underwater endoscopic mucosal resection: The third way for en bloc resection of colonic lesions? United European Gastroenterol J 2016;4:595-8.
14. Hsieh YH, Binmoeller KF, Leung F. Underwater Polypectomy: Heat-Sink Effect in an Experimental Model. Gastrointest Endosc 2016;83:AB385.
15. Jovanovic I, Caro C, Neumann H, et al. The submucosal cushion does not improve the histologic evaluation of adenomatous colon polyps resected by snare polypectomy. Clin Gastroenterol Hepatol 2011;9:910-3.
16. Belderbos TD, Leenders M, Moons LM, et al. Local recurrence after endoscopic mucosal resection of nonpedunculated colorectal lesions: systematic review and meta-analysis. Endoscopy 2014;46:388-402.
Artículos relacionados

Carta

Vaginal lesion as first manifestation of colorectal disease

DOI: 10.17235/reed.2022.9270/2022

Imagen en Patología Digestiva

Anemia induced by hemangioma at the duodenal papilla, resected by endoscopic mucosal resection

DOI: 10.17235/reed.2022.8439/2021

Revisión

Enfermedad inflamatoria intestinal y trasplante de órganos sólido

DOI: 10.17235/reed.2020.7361/2020

Carta

Medullary colorectal carcinoma. Do we really know it?

DOI: 10.17235/reed.2020.6728/2019

Carta

The rectosigmoid junction: are limits important?

DOI: 10.17235/reed.2019.5983/2018

Editorial

Cribado del cáncer colorrectal y supervivencia

DOI: 10.17235/reed.2018.5870/2018

Revisión

Lesiones serradas y síndrome de poliposis serrada

DOI: 10.17235/reed.2017.4065/2015

Carta al Editor

Metástasis traqueobronquiales de cáncer colorrectal

DOI: 10.17235/reed.2016.4080/2015

Instrucciones para citar
Rodríguez Sánchez J, Uchima Koecklin H, González López L, Cuatrecasas M, de la Santa Belda E, Olivencia Palomar P, et all. Short and long-term outcomes of underwater EMR compared to the traditional procedure in the real clinical practice. 6009/2018


Descargar en un gestor de citas

Descargue la cita de este artículo haciendo clic en uno de los siguientes gestores de citas:

Métrica
Este artículo ha sido visitado 1058 veces.
Este artículo ha sido descargado 467 veces.

Estadísticas de Dimensions


Estadísticas de Plum Analytics

Ficha Técnica

Recibido: 29/10/2018

Aceptado: 31/01/2019

Prepublicado: 11/06/2019

Publicado: 04/07/2019

Tiempo de revisión del artículo: 87 días

Tiempo de prepublicación: 225 días

Tiempo de edición del artículo: 248 días


Compartir
Este artículo ha sido valorado por 1 lectores .
Valoración del lector:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
La REED es el órgano oficial de la Sociedad Española de Patología Digestiva, la SociedadEspañola de Endoscopia Digestiva y la Asociación Española de Ecografía Digestiva
Política de cookies Política de Privacidad Aviso Legal © Copyright 2023 y Creative Commons. Revista Española de Enfermedades Digestivas