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27.08.2020 | Review Article

Effectiveness and safety of underwater techniques in gastrointestinal endoscopy: a comprehensive review of the literature

verfasst von: Marcello Maida, Sandro Sferrazza, Alberto Murino, Andrea Lisotti, Nikolaos Lazaridis, Alessandro Vitello, Pietro Fusaroli, Giovanni de Pretis, Emanuele Sinagra

Erschienen in: Surgical Endoscopy | Ausgabe 1/2021

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Abstract

Background

Conventional endoscopic resection techniques such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), represent the standard of care for treatment of superficial gastrointestinal lesions. In 2012 a novel technique called underwater endoscopic mucosal resection (U-EMR) was described by Binmoeller and colleagues. This substantial variation from the standard procedure was afterwards applied at endoscopic submucosal dissection (U-ESD) and recently proposed also for peroral endoscopic myotomy (U-POEM) and endoscopic full-thickness resection (U-EFTR).

Methods

This paper aims to perform a comprehensive review of the current literature related to supporting the underwater resection techniques with the aim to evaluate their safety and efficacy.

Results

Based on the current literature U-EMR appears to be feasible and safe. Comparison studies showed that U-EMR is associated with higher “en-bloc” and R0 resection rates for colonic lesions, but lower “en-bloc” and R0 resection rates for duodenal non-ampullary lesions, compared to standard EMR. In contrast to U-EMR, little evidence supporting U-ESD are currently available. A single comparison study on gastric lesions showed that U-ESD had shorter procedural times and allowed a similar “en-bloc” resection rates compared to standard ESD. No comparison studies between U-ESD and ESD are available for colonic lesions. Finally, only some anecdotal experiences have been reported for U-POEM or U-EFTR, and the feasibility and effectiveness of these techniques need to be further investigated.

Conclusions

Further prospective studies are necessary to better explore the advantages of underwater techniques compared to the respective standards of care, especially in the setting of U-ESD where consistent data are lacking and where standardization of the technique is needed.

Kaltenbach T, Anderson JC, Burke CA, Dominitz JA, Gupta S, Lieberman D, Robertson DJ, Shaukat A, Syngal S, Rex DK (2020) Endoscopic removal of colorectal lesions-recommendations by the US Multi-Society Task Force on colorectal cancer. Gastroenterology 158(4):1095–1129PubMed

Ferlitsch M, Moss A, Hassan C, Bhandari P, Dumonceau JM, Paspatis G, Jover R, Langner C, Bronzwaer M, Nalankilli K, Fockens P, Hazzan R, Gralnek IM, Gschwantler M, Waldmann E, Jeschek P, Penz D, Heresbach D, Moons L, Lemmers A, Paraskeva K, Pohl J, Ponchon T, Regula J, Repici A, Rutter MD, Burgess NG, Bourke MJ (2017) Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy 49(3):270–297PubMed

Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T, Repici A, Vieth M, De Ceglie A, Amato A, Berr F, Bhandari P, Bialek A, Conio M, Haringsma J, Langner C, Meisner S, Messmann H, Morino M, Neuhaus H, Piessevaux H, Rugge M, Saunders BP, Robaszkiewicz M, Seewald S, Kashin S, Dumonceau JM, Hassan C, Deprez PH (2015) Endoscopic submucosal dissection: ESGE guideline. Endoscopy 47:829–854PubMed

Norton ID, Wang L, Levine SA, Burgart LJ, Hofmeister EK, Rumalla A, Gostout CJ, Petersen BT (2002) Efficacy of colonic submucosal saline solution injection for the reduction of iatrogenic thermal injury. Gastrointest Endosc 56:95–99PubMed

Falchuk ZM, Griffin PH (1984) A technique to facilitate colonoscopy in areas of severe diverticular disease. N Engl J Med 310:598PubMed

Baumann UA (1999) Water intubation of the sigmoid colon: water instillation speeds up left-sided colonoscopy. Endoscopy 31:314–317PubMed

Hamamoto N, Nakanishi Y, Morimoto N, Inoue H, Tatukawa M, Nakata S, Kawai Y, Kurihara N, Ookuchi S, Shizuku T, Yamamoto S, Hamamoto S, Kazumori H, Kinoshita Y (2002) A new water instillation method for colonoscopy without sedation as performed by endoscopists in-training. Gastrointest Endosc 56:825–828PubMed

Leung FW, Harker JO, Jackson G, Okamoto KE, Behbahani OM, Jamgotchian NJ, Aharonian HS, Guth PH, Mann SK, Leung JW (2010) A proof-of-principle, prospective, randomized, controlled trial demonstrating improved outcomes in scheduled unsedated colonoscopy by the water method. Gastrointest Endosc 72:693–700PubMed

Rex DK (2014) Water exchange vs. water immersion during colonoscope insertion. Am J Gastroenterol 109(9):1401–1403PubMed

10.

Radaelli F, Paggi S, Amato A, Terruzzi V (2010) Warm water infusion versus air insufflation for unsedated colonoscopy: a randomized, controlled trial. Gastrointest Endosc 72:701–709PubMed

11.

Pohl J, Messer I, Behrens A, Kaiser G, Mayer G, Ell C (2011) Water infusion for cecal intubation increases patient tolerance, but does not improve intubation of unsedated colonoscopies. Clin Gastroenterol Hepatol 9:1039–1043PubMed

12.

Leung CW, Kaltenbach T, Soetikno R, Wu KK, Leung FW, Friedland S (2010) Water immersion versus standard colonoscopy insertion technique: randomized trial shows promise for minimal sedation. Endoscopy 42:557–563PubMed

13.

Cadoni S, Falt P, Rondonotti E, Radaelli F, Fojtik P, Gallittu P, Liggi M, Amato A, Paggi S, Smajstrla V, Urban O, Erriu M, Koo M, Leung FW (2017) Water exchange for screening colonoscopy increases adenoma detection rate: a multicenter, double-blinded, randomized controlled trial. Endoscopy 49(5):456–467PubMed

14.

Cadoni S, Hassan C, Frazzoni L, Ishaq S, Leung FW (2018) Impact of water exchange colonoscopy on endoscopy room efficiency: a systematic review and meta-analysis. Gastrointest Endosc 89(1):159–167PubMed

15.

Fuccio L, Frazzoni L, Hassan C, La Marca M, Paci V, Smania V, De Bortoli N, Bazzoli F, Repici A, Rex D, Cadoni S (2018) Water exchange colonoscopy increases adenoma detection rate: a systematic review with network meta-analysis of randomized controlled studies. Gastrointest Endosc 88(4):589–597.e11PubMed

16.

Sugimoto S, Mizukami T (2015) Diagnostic and therapeutic applications of water-immersion colonoscopy. World J Gastroenterol 21(21):6451–6459PubMedPubMedCentral

17.

Binmoeller KF, Weilert F, Shah J, Bhat Y, Kane S (2012) Underwater" EMR without submucosal injection for large sessile colorectal polyps (with video). Gastrointest Endosc 75(5):1086–1091PubMed

18.

Binmoeller KF, Shah JN, Bhat YM, Kane SD (2013) "Underwater" EMR of sporadic laterally spreading nonampullary duodenal adenomas (with video). Gastrointest Endosc 78(3):496–502PubMed

19.

Akasaka T, Takeuchi Y, Uedo N, Ishihara R, Iishi H (2017) "Underwater" endoscopic submucosal dissection for superficial esophageal neoplasms. Gastrointest Endosc 85(1):251–252PubMed

20.

Yoshii S, Hayashi Y, Matsui T, Aoi K, Tsujii Y, Iijima H, Takehara T (2016) "Underwater" endoscopic submucosal dissection: a novel technique for complete resection of a rectal neuroendocrine tumor. Endoscopy 48(Suppl 1):E67–E68PubMed

21.

Tanaka S, Tamegai Y, Tsuda S, Saito Y, Yahagi N, Yamano HO (2010) Multicenter questionnaire survey on the current situation of colorectal endoscopic submucosal dissection in Japan. Dig Endosc 22(Suppl. 1):S2–S8PubMed

22.

Binmoeller KF, Hamerski CM, Shah JN, Bhat YM, Kane SD, Garcia-Kennedy R (2015) Attempted underwater en bloc resection for large (2–4 cm) colorectal laterally spreading tumors (with video). Gastrointest Endosc 81(3):713–718PubMed

23.

Spadaccini M, Fuccio L, Lamonaca L, Frazzoni L, Maselli R, Di Leo M, Galtieri PA, Craviotto V, D'Amico F, Hassan C, Repici A (2019) Underwater EMR for colorectal lesions: a systematic review with meta-analysis (with video). Gastrointest Endosc 89(6):1109–1116.e4PubMed

24.

Yamashina T, Uedo N, Akasaka T, Iwatsubo T, Nakatani Y, Akamatsu T, Kawamura T, Takeuchi Y, Fujii S, Kusaka T, Shimokawa T (2019) Comparison of underwater vs conventional endoscopic mucosal resection of intermediate-size colorectal polyps. Gastroenterology 157(2):451–461PubMed

25.

Schenck RJ, Jahann DA, Patrie JT, Stelow EB, Cox DG, Uppal DS, Sauer BG, Shami VM, Strand DS, Wang AY (2017) 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 31(10):4174–4183. https://doi.org/10.1007/s00464-017-5474-4CrossRefPubMed

26.

Chien HC, Uedo N, Hsieh PH (2019) Comparison of underwater and conventional endoscopic mucosal resection for removing sessile colorectal polyps: a propensity-score matched cohort study. Endosc Int Open 7(11):E1528–E1536. https://doi.org/10.1055/a-1007-1578CrossRefPubMedPubMedCentral

27.

Kim HG, Thosani N, Banerjee S, Chen A, Friedland S (2014) Underwater endoscopic mucosal resection for recurrences after previous piecemeal resection of colorectal polyps (with video). Gastrointest Endosc 80(6):1094–1102PubMed

28.

Cadoni S, Liggi M, Gallittu P, Mura D, Fuccio L, Koo M, Ishaq S (2018) Underwater endoscopic colorectal polyp resection: feasibility in everyday clinical practice. United Eur Gastroenterol J 6(3):454–462. https://doi.org/10.1177/2050640617733923CrossRef

29.

Binmoeller KF, Hamerski CM, Shah JN, Bhat YM, Kane SD (2016) Underwater EMR of adenomas of the appendiceal orifice (with video). Gastrointest Endosc 83:638–642PubMed

30.

Takeuchi Y, Tonai Y, Ikeda K (2017) Underwater endoscopic mucosal resection for a superficial polyp located at the anastomosis after surgical colectomy. Dig Endosc 29(Suppl 2):67–68PubMed

31.

Hiramatsu R, Takeshita A, Taguchi M, Takeuchi Y (2007) Symptomatic hyponatremia after voluntary excessive water ingestion in a patient without psychiatric problems. Endocr J 54:643–645PubMed

32.

Despott EJ, Murino A (2017) Saline-immersion therapeutic endoscopy (SITE): An evolution of underwater endoscopic lesion resection). Digest Liver Dis 49(12):1376

33.

Nagata M (2018) Usefulness of underwater endoscopic submucosal dissection in saline solution with a monopolar knife for colorectal tumors. Gastrointest Endosc 87(5):1345–1353PubMed

34.

Yamasaki Y, Uedo N, Takeuchi Y, Higashino K, Hanaoka N, Akasaka T, Kato M, Hamada K, Tonai Y, Matsuura N, Kanesaka T, Arao M, Suzuki S, Iwatsubo T, Shichijo S, Nakahira H, Ishihara R, Iishi H (2018) Underwater endoscopic mucosal resection for superficial nonampullary duodenal adenomas. Endoscopy 50(2):154–158. https://doi.org/10.1055/s-0043-119214CrossRefPubMed

35.

Shibukawa G, Irisawa A, Sato A, Abe Y, Yamabe A, Arakawa N, Takasaki Y, Maki T, Yoshida Y, Igarashi R, Yamamoto S, Ikeda T, Hojo H (2018) Endoscopic mucosal resection performed underwater for nonampullary duodenal epithelial tumor: evaluation of feasibility and safety. Gastroenterol Res Pract 2018:7490961. https://doi.org/10.1155/2018/7490961CrossRefPubMedPubMedCentral

36.

Curcio G, Granata A, Ligresti D, Tarantino I, Barresi L, Liotta R, Traina M (2015) Underwater submucosal resection of a carcinoid tumor of the duodenal bulb. Gastrointest Endosc 81(5):1272–1273PubMed

37.

Anderloni A, Murino A, Jovani M, Battista S, Repici A (2016) Underwater endoscopic mucosal resection of a duodenal neuroendocrine tumor. Gastrointest Endosc 83(1):259–260. https://doi.org/10.1016/j.gie.2015.08.001CrossRefPubMed

38.

Elli L, Branchi F, Ferretti F, Penagini R (2017) Duodenal underwater polypectomy in celiac disease. Dig Liver Dis 49(7):822. https://doi.org/10.1016/j.dld.2017.03.008CrossRefPubMed

39.

Kiguchi Y, Kato M, Nakayama A, Sasaki M, Mizutani M, Tsutsumi K, Akimoto T, Takatori Y, Mutaguchi M, Takabayashi K, Ochiai Y, Maehata T, Kanai T, Yahagi N (2019) Feasibility study comparing underwater endoscopic mucosal resection and conventional endoscopic mucosal resection for superficial non-ampullary duodenal epithelial tumor < 20 mm. Dig Endosc. https://doi.org/10.1111/den.13524CrossRefPubMed

40.

Granata A, Curcio G, Ligresti D, Barresi L, Tarantino I, Liotta R, Traina M (2014) Endoscopic ampullectomy: to inject or not to inject? The underwater technique. Endoscopy 46(Suppl 1):E478–E479. https://doi.org/10.1055/s-0034-1377538CrossRefPubMed

41.

Flynn MA, Wang AY (2014) Underwater endoscopic mucosal resection of large duodenal adenomas (video). Video J Encycl GI Endosc 2(3–4):84–86

42.

Tonai Y, Takeuchi Y, Akita H, Takada R, Ishihara R, Takami M, Iishi H (2016) Iatrogenic duodenal perforation during underwater ampullectomy: endoscopic repair using polyglycolic acid sheets. Endoscopy 48(Suppl 1):E97–E98PubMed

43.

Mori G, Nonaka S, Oda I, Abe S, Suzuki H, Yoshinaga S, Nakajima T, Saito Y (2015) Novel strategy of endoscopic submucosal dissection using an insulation-tipped knife for early gastric cancer: near-side approach method. Endosc Int Open 3:E425–E431PubMedPubMedCentral

44.

Akasaka T, Tonai Y, Hamada K, Takeuchi Y, Uedo N, Ishihara R, Iishi H (2017) Dive to the underwater world: a water immersion technique for endoscopic submucosal dissection of gastric neoplasms. Video of the month. Am J Gastroenterol 112:985PubMed

45.

Yoshii S, Hayashi Y, Tsujii Y, Takehara T (2017) Underwater endoscopic submucosal dissection: a novel resection strategy for early gastric cancer located on the greater curvature of the gastric body. Ann Gastroenterol 30(3):364PubMedPubMedCentral

46.

Harada H, Murakami D, Suehiro S, Nakahara R, Ujihara T, Sagami R, Katsuyama Y, Hayasaka K, Amano Y (2018) Water-pocket endoscopic submucosal dissection for superficial gastric neoplasms (with video). Gastrointest Endosc 88(2):253–260PubMed

47.

Nagata M (2018) Underwater endoscopic submucosal dissection in saline solution using a bent-type knife for duodenal tumor. VideoGIE 3(12):375–377. https://doi.org/10.1016/j.vgie.2018.09.015CrossRefPubMedPubMedCentral

48.

Rodríguez Sánchez J, Úbeda Muñoz M, de la Santa BE, Olivencia Palomar P, Olmedo CJ (2018) Underwater hybrid endoscopic submucosal dissection in a rectal polyp: a case report of a new application of "underwater endoscopy". Rev EspEnferm Dig 110(1):62–64

49.

Despott EJ, Hirayama Y, Lazaridis N, Koukias N, Telese A, Hayashi Y, Miura Y, Yamamoto H, Murino A (2019) Saline immersion therapeutic endoscopy facilitated pocket-creation method for endoscopic submucosal dissection (with video). Gastrointest Endosc 89(3):652–653. https://doi.org/10.1016/j.gie.2018.10.005CrossRefPubMed

50.

Iacopini F, Gotoda T, Montagnese F, Andrei F, Saito Y (2017) Underwater endoscopic submucosal dissection of a nonpolypoid superficial tumor spreading into the appendix. VideoGIE 2(4):82–84PubMedPubMedCentral

51.

Binmoeller KF, Bhat YM (2016) Underwater peroral endoscopic myotomy. Gastrointest Endosc 83(2):454. https://doi.org/10.1016/j.gie.2015.08.066CrossRefPubMed

52.

Uchima H, Colan J, Marín I, Moreno V, Larios G, Tazi R, Serra J (2020) Underwater peroral endoscopic myotomy (u-POEM) after tension capnoperitoneum and capnothorax during POEM. Endoscopy. https://doi.org/10.1055/a-1144-2547CrossRefPubMed

53.

Granata A, Amata M, Ligresti D, Bonsignore P, Li Petri S, Traina M (2019) Underwater full-thickness resection of a duodenal bulb gastrointestinal stromal tumor with OverStitch defect repair. Endoscopy 51(8):E207–E208. https://doi.org/10.1055/a-0881-2702CrossRefPubMed

54.

Wang AY, Flynn MM, Patrie JT, Cox DG, Bleibel W, Mann JA, Sauer BG, Shami VM (2014) Underwater endoscopic mucosal resection of colorectal neoplasia is easily learned, efficacious, and safe. Surg Endosc 28(4):1348–1354PubMed

55.

Uedo N, Nemeth A, Johansson GW, Toth E, Thorlacius H (2015) Underwater endoscopic mucosal resection of large colorectal lesions. Endoscopy 47:172–174PubMed

56.

Curcio G, Granata A, Ligresti D, Tarantino I, Barresi L, Liotta R, Traina M (2015) Underwater colorectal EMR: remodeling endoscopic mucosal resection. Gastrointest Endosc 81(5):1238–1242PubMed

57.

Amato A, Radaelli F, Spinzi G (2016) Underwater endoscopic mucosal resection: the third way for en bloc resection of colonic lesions? United Eur Gastroenterol J 4:595–598

58.

Siau K, Ishaq S, Cadoni S, Kuwai T, Yusuf A, Suzuki N (2018) Feasibility and outcomes of underwater endoscopic mucosal resection for ≥ 10 mm colorectal polyps. Surg Endosc 32(6):2656–2663. https://doi.org/10.1007/s00464-017-5960-8CrossRefPubMed

59.

Sandhu DS, Lee YJ, Gerke H (2018) Underwater endoscopic mucosal resection: an alternative treatment for large colorectal polyp removal. Minerva Gastroenterol Dietol 64(2):106–110. https://doi.org/10.23736/S1121-421X.17.02444-8CrossRefPubMed

60.

Kawamura T, Sakai H, Ogawa T, Sakiyama N, Ueda Y, Shirakawa A, Okada Y, Sanada K, Nakase K, Mandai K, Suzuki A, Morita A, Tanaka K, Uno K, Yasuda K (2018) Feasibility of underwater endoscopic mucosal resection for colorectal lesions: a single center study in Japan. Gastroenterology Res 11(4):274–279. https://doi.org/10.14740/gr1021wCrossRefPubMedPubMedCentral

61.

Uedo N, Nemeth A, Toth E, Thorlacius H (2014) Underwater endoscopic mucosal resection of a large depressed adenoma in the ileum. Endoscopy 46(Suppl 1):E336–E337. https://doi.org/10.1055/s-0034-1377280CrossRefPubMed

62.

Kawaguti FS, de Oliveira JF, da Costa Martins B, Sorbello MP, Retes FA, Ribeiro U, Maluf-Filho F (2015) Underwater endoscopic resection of a neuroendocrine rectal tumor. Endoscopy. 47(Suppl 1):E513–E514. https://doi.org/10.1055/s-0034-1393224CrossRefPubMed

63.

Ishaq S, Tontini GE, Neumann H (2016) Underwater endoscopic mucosal resection without submucosal lift. Endoscopy 48(S 01):E371. https://doi.org/10.1055/s-0042-120263CrossRefPubMed

64.

Ponugoti PL, Rex DK (2016) Perforation during underwater EMR. Gastrointest Endosc 84(3):543–544. https://doi.org/10.1016/j.gie.2016.01.021CrossRefPubMed

65.

Hosotani K, Imai K, Hotta K, Ito S, Ono H (2017) Underwater endoscopic mucosal resection for complete R0 removal of a residual adenoma at a perforated scar in a patient with colostomy. Endoscopy 49(S 01):E121–E122. https://doi.org/10.1055/s-0043-104520CrossRefPubMed

66.

Hamada K, Uedo N, Tanishita H (2018) Underwater endoscopic mucosal resection of an intramucosal carcinoma located from the lower rectum to the anal canal. Dig Endosc 30(1):119–120. https://doi.org/10.1111/den.12972CrossRefPubMed

67.

Shichijo S, Yamaguchi Y, Nakahara M, Imai Y, Ishihara R (2020) Underwater EMR of a colonic adenoma surrounded by diverticula. VideoGIE 5(4):157–158. https://doi.org/10.1016/j.vgie.2019.12.007CrossRefPubMedPubMedCentral

68.

Chaves DM, Brito HP, Chaves LT, Safatle-Ribeiro AV, Fava G, de Moura EGH, Sugai BM (2016) Underwater endoscopic resection: an alternative for difficult colorectal polyps. VideoGIE 1(4):82–84. https://doi.org/10.1016/j.vgie.2016.11.001CrossRefPubMedPubMedCentral

69.

Mavrogenis G, Mavrogenis I, Anastasiadis S, Bazerbachi F (2019) Underwater endoscopic submucosal dissection in saline solution with rubber-band countertraction for a cecal polyp extending into a diverticulum. Ann Gastroenterol 32(5):527. https://doi.org/10.20524/aog.2019.0396CrossRefPubMedPubMedCentral

70.

Yamasaki Y, Takeuchi Y, Uedo N, Hanaoka N, Higashino K, Ishihara R, Iishi H (2017) Line-assisted complete closure of duodenal mucosal defects after underwater endoscopic mucosal resection. Endoscopy 49(S 01):E37–E38. https://doi.org/10.1055/s-0042-120707CrossRefPubMed

71.

Nakahira H, Takeuchi Y, Kanesaka T, Uedo N, Ishihara R (2019) Wide-field underwater EMR followed by line-assisted complete closure for a large duodenal adenoma. VideoGIE 4(10):469–471. https://doi.org/10.1016/j.vgie.2019.07.004CrossRefPubMedPubMedCentral

Titel: Effectiveness and safety of underwater techniques in gastrointestinal endoscopy: a comprehensive review of the literature
verfasst von: Marcello Maida
Sandro Sferrazza
Alberto Murino
Andrea Lisotti
Nikolaos Lazaridis
Alessandro Vitello
Pietro Fusaroli
Giovanni de Pretis
Emanuele Sinagra
Publikationsdatum: 27.08.2020
Verlag: Springer US
Erschienen in: Surgical Endoscopy / Ausgabe 1/2021
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-020-07907-8

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