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Surg Endosc. 2018 Jun;32(6):2656-2663. doi: 10.1007/s00464-017-5960-8. Epub 2017 Nov 3.

Feasibility and outcomes of underwater endoscopic mucosal resection for ≥ 10 mm colorectal polyps.

Author information

1
Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK.
2
Department of Gastroenterology, Dudley Group Hospitals NHS Foundation Trust, Dudley, UK.
3
Department of Gastroenterology, Dudley Group Hospitals NHS Foundation Trust, Dudley, UK. sauid.ishaq@dgh.nhs.uk.
4
Department of Medicine, Birmingham City University, Birmingham, B5 5JU, UK. sauid.ishaq@dgh.nhs.uk.
5
Digestive Endoscopy Unit, CTO Hospital, Iglesias, Italy.
6
Department of Gastroenterology, National Hospital Organization, Kure Medical Centre and Chugoku Cancer Centre, Kure, Japan.
7
Wolfson Unit for Endoscopy, St Mark's Hospital, London, UK.

Abstract

BACKGROUND:

Underwater endoscopic mucosal resection (UEMR) is an emerging strategy for the management of colorectal polyps. We aimed to evaluate the efficacy and safety of UEMR for clinically significant (≥ 10 mm) colorectal polyps.

METHODS:

We performed a prospective dual-centre study of polyps ≥ 10 mm undergoing UEMR between June 2014 and March 2017. Outcomes measured comprised: (1) completeness of resection at index UEMR, (2) intraprocedural and 30-day complications, (3) rates and predictors of submucosal lift, en bloc resection, polyp/adenoma recurrence and (4) pain score. Endoscopy records were correlated with histology.

RESULTS:

85 patients underwent UEMR of 97 polyps. Resection was endoscopically complete at index UEMR in 97.9%. The median pain score was 0 (no pain). Submucosal lift was required in 29.9% and correlated with polyp size ≥ 30 mm (p = 0.03) and clip placement (p = 0.004). En bloc resection was achieved in 45.4%, and inversely correlated with polyp size ≥ 20 mm (p < 0.001). 30-day complications (4.1%) were minor and consisted of intraprocedural bleeding (n = 2) and delayed bleeding (n = 2). 60.8% attended endoscopy post-UEMR after a median interval of 6 months, with 20.3% polyp and 13.6% adenoma recurrence. Polyp recurrence was associated with piecemeal resection (p = 0.04), recurrent polyp (p = 0.02), female sex (p = 0.01) and poor access (p = 0.005). Predictors for adenoma recurrence included female gender (p = 0.01) and difficult access (p < 0.001). Recurrence rates did not differ with polyp size, site, morphology, dysplasia status, submucosal injection, patient age, or study centre.

CONCLUSIONS:

UEMR is an effective, safe and well tolerated option for significant colorectal polyps. Piecemeal resection, recurrent polyp, female gender, and difficult access are predictors of post-UEMR polyp recurrence.

KEYWORDS:

EMR; Outcomes; Polypectomy; Underwater

PMID:
29101560
DOI:
10.1007/s00464-017-5960-8
[Indexed for MEDLINE]

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