Mo1734 EFFICACY AND SAFETY OF UNDERWATER ENDOSCOPIC MUCOSAL RESECTION IN COMPARISON TO CONVENTIONAL EMR FOR THE REMOVAL OF COLON POLYPS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Background and study aims Evidence from recent trials comparing conventional endoscopic mucosal resection (EMR) to underwater EMR (UEMR) have matured. However, studies comparing UEMR to endoscopic submucosal dissection (ESD) are lacking. Hence, we sought to conduct a comprehensive network meta-analysis to compare the efficacy of UEMR, ESD, and EMR. Methods Embase and Medline databases were searched from inception to December 2020 for articles comparing UEMR with EMR and ESD. Outcomes of interest included rates of en bloc and complete polyp resection, risk of perforation and bleeding, and local recurrence. A network meta-analysis comparing all three approaches was conducted. In addition, a conventional comparative meta-analysis comparing UEMR to EMR was performed. Analysis was stratified according to polyp sizes (< 10 mm, ≥ 10 mm, and ≥ 20 mm). Results Twenty-two articles were included in this study. For polyps ≥ 10 mm, UEMR was inferior to ESD in achieving en bloc resection (P = 0.02). However, UEMR had shorter operating time for polyps ≥ 10 mm (P < 0.001), and ≥20 mm (P = 0.019) with reduced perforation risk for polyps ≥ 10 mm (P = 0.05) compared to ESD. In addition, en bloc resection rates were similar between UEMR and EMR, although UEMR had reduced recurrence for polyps ≥ 10 mm (P = 0.013) and ≥ 20 mm (P = 0.014). UEMR also had shorter mean operating than EMR for polyps ≥ 10 mm (P < 0.001) and ≥ 20 mm (P < 0.001). Risk of bleeding and perforation with UEMR and EMR were similar for polyp of all sizes. Conclusions UEMR has demonstrated technical and oncological outcomes comparable to ESD and EMR, along with a desirable safety profile. UEMR appears to be a safe and effective alternative to conventional methods for resection of polyps ≥ 10 mm.

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276 – Efficacy and Safety of Hot and Cold Endoscopic Mucosal Resection for Resection of Sessile Serrated Polyps: A Systematic Review and Pooled Analysis

Gastroenterology ◽

10.1016/s0016-5085(19)36920-3 ◽

2019 ◽

Vol 156 (6) ◽

pp. S-55

Author(s):

Viveksandeep Thoguluva Chandrasekar ◽

Abhiram Duvvuri ◽

Muhammad Aziz ◽

Chandra S. Dasari ◽

Ramprasad Jegadeesan ◽

...

Keyword(s):

Systematic Review ◽

Endoscopic Mucosal Resection ◽

Pooled Analysis ◽

Efficacy And Safety ◽

Serrated Polyps ◽

Mucosal Resection

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Efficacy and safety of modified endoscopic mucosal resection for rectal neuroendocrine tumors: a meta-analysis

Zeitschrift für Gastroenterologie ◽

10.1055/a-1062-8897 ◽

2020 ◽

Vol 58 (02) ◽

pp. 137-145 ◽

Cited By ~ 1

Author(s):

Jian-Chun Zheng ◽

Kai Zheng ◽

Shuai Zhao ◽

Zhen-Ning Wang ◽

Hui-Mian Xu ◽

...

Keyword(s):

Endoscopic Mucosal Resection ◽

Neuroendocrine Tumors ◽

Meta Analysis ◽

Complete Resection ◽

Lateral Margin ◽

Endoscopic Polypectomy ◽

Efficacy And Safety ◽

Margin Involvement ◽

Mucosal Resection ◽

Significant Difference

Abstract Purpose Rectal neuroendocrine tumors are rare with good prognosis. Several endoscopic methods such as endoscopic polypectomy, endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR), and modified endoscopic mucosal resection (m-EMR) are used in the treatment of rectal neuroendocrine tumors. Although m-EMR is derived from traditional EMR, it has not been widely used in clinical practice. In this study, we compared the efficacy and safety of EMR and m-EMR in the treatment of rectal neuroendocrine tumors by performing a meta-analysis. Materials and Methods We searched PubMed, Web of Science, and EMBASE index up to the end of January 2017 for all published literature about EMR and m-EMR in the treatment of rectal neuroendocrine tumors. Results A total of 11 studies involving 811 patients were included. The pooled data suggested that there was a significantly higher rate of histologic complete resection and endoscopic complete resection among patients treated with m-EMR than those treated with EMR (histologic complete resection: OR = 0.23, 95 % CI = 0.10–0.51, p < 0.01; endoscopic complete resection: OR = 0.13, 95 % CI = 0.02–0.74, p = 0.02). The procedure time of EMR was longer than m-EMR (MD = 2.40, 95 % CI = 0.33–4.46, p = 0.02). There was a significantly higher rate of vertical margin involvement among patients treated with EMR than those treated with m-EMR; whereas, there was no significant difference of lateral margin involvement between the m-EMR and EMR groups (vertical margin involvement: OR = 5.00, 95 % CI = 2.67–9.33, p < 0.01; lateral margin involvement: OR = 1.44, 95 % CI = 0.48–4.37, p = 0.52). There was no significant difference in mean tumor size among patients treated with m-EMR versus those treated with EMR (MD = −0.30, 95 % CI = −0.75–0.14, p = 0.18); further, there was no significant difference in endoscopic mean sizes of the tumor and pathological mean sizes of the tumor between the m-EMR and EMR groups (endoscopic mean sizes of the tumor: MD = 0.20, 95 % CI = −0.44–0.84, p = 0.43; pathological mean sizes of the tumor: MD = 0.62, 95 % CI = −0.68–1.92, p = 0.05). No significant differences were detected among the treatment groups with regard to complications (bleeding: OR = 0.87, 95 % CI = 0.39–1.95, p = 0.73; complications (bleeding and perforation): OR = 0.87, 95 % CI = 0.40–1.88, p = 0.73). Conclusion The efficacy of m-EMR are better than EMR among patients undergoing endoscopic treatment of rectal neuroendocrine tumors, and the safety of m-EMR is equivalent to EMR treatment.

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