New methodsClinical endoscopyUnderwater colorectal EMR: remodeling endoscopic mucosal resection
Section snippets
Patients and methods
UEMR was performed on 72 consecutive patients referred for endoscopic treatment of 81 colorectal lesions.
Colonoscopy was performed with an adult high-definition (HD) single-channel colonoscope with an auxiliary water jet (CF-H190L; Olympus Medical Systems, Center Valley, Pa). Lesions were assessed by using underwater image enhancement together with HD white-light imaging and narrow-band imaging (NBI) to determine suitability for resection. Lesions that showed signs of invasive cancer
Results
From June 2013 to June 2014, 72 consecutive patients underwent endoscopic treatment of 81 colorectal polyps (Table 1). The mean polyp size resected was 18.6 mm (range 10–50 mm); 47 (58%) polyps were 15 mm or larger. The location, morphology, and histopathology of colorectal lesions removed by UEMR are listed in Table 1.
A total of 52 lesions (64.2%) were sessile (Paris type 0-Is), 8 (9.9%) were semipedunculated (Paris type 0-Isp), 18 (22.2%) were laterally spreading tumors slightly elevated
Discussion
In the United States, it has been estimated that more than 14 million colonoscopies are performed per year, of which a substantial proportion (for careful colonoscopists more than half) include 1 or more polypectomies. Polypectomy performed during colonoscopy is the means of preventing colorectal cancer and is the most important therapeutic procedure in GI medicine.1, 2, 3, 4
Although they are effective and safe in expert hands, both EMR and endoscopic submucosal dissection require specialized
Acknowledgments
The authors thank Warren Blumberg for editorial assistance.
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Underwater versus conventional EMR for nonpedunculated colorectal lesions: a randomized clinical trial
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2021, GastroenterologyCitation Excerpt :The aim was to find out if improvements in UEMR techniques during the trial might contribute to better en bloc resection rates. Consistent with the findings of several studies, which have shown that endoscopists skilled in CEMR easily adopt UEMR without specific training54–56 and that the learning curve for CEMR often plateaus at 100 cases,57 we found no statistically significant difference regarding the en bloc resection rate between patients undergoing UEMR in the 2 time periods of the study. Even though operator A performed more procedures than operator B, an internal evaluation of the performance of both operators showed that this did not affect the overall outcome of the study.
Higher rate of en bloc resection with underwater than conventional endoscopic mucosal resection: A meta-analysis
2021, Digestive and Liver DiseaseCitation Excerpt :Contrariwise, one could argue that this benefit might vary according to each endoscopist`s level of expertise. Scant evidence suggest that U-EMR performs well in the hands of endoscopists, even without previous dedicated training [29]. However, in the only study including expert and non-expert endoscopists [19], results were not stratified by operator's technical proficiency, preventing conclusions to be drawn.
Water-assisted colonoscopy: an international modified Delphi review on definitions and practice recommendations
2021, Gastrointestinal EndoscopyEndoscopic treatment of preneoplastic or early lesions
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DISCLOSURE: All authors disclosed no financial relationships relevant to this article.