scholarly journals Snare tip soft coagulation (STSC) after endoscopic mucosal resection (EMR) of large (> 20 mm) non pedunculated colorectal polyps: a systematic review and meta-analysis

2022 ◽  
Vol 10 (01) ◽  
pp. E74-E81
Author(s):  
Saurabh Chandan ◽  
Antonio Facciorusso ◽  
Daryl Ramai ◽  
Smit Deliwala ◽  
Babu P. Mohan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Endoscopic Mucosal Resection ◽  
Meta Analysis ◽  
Colorectal Polyps ◽  
Resection Margins ◽  
Effective Technique ◽  
Delayed Bleeding ◽  
Adenoma Recurrence ◽  
Mucosal Resection ◽  
Soft Coagulation

Abstract Background and study aims Endoscopic mucosal resection (EMR) of laterally spreading tumors (LSTs) > 20 mm in size can be challenging. Piecemeal EMR of these lesions results in high rates of adenoma recurrence at first surveillance colonoscopy (SC1). Snare tip soft coagulation (STSC) of post resection margins is a safe and effective technique to prevent adenoma recurrence. We conducted a systematic review and meta-analysis to evaluate the effectiveness and safety of this technique. Patients and methods Multiple databases were searched through April 2021 for studies that reported on outcomes of post EMR STSC for LSTs > 20 mm in size. Meta-analysis was performed to determine pooled odds of adenoma recurrence as well as pooled proportion of adverse events including intraprocedural and delayed bleeding as well as intraprocedural perforation events. Results Six studies including two randomized controlled trials (RCT) and four cohort studies with 2122 patients were included in the final analysis. Overall pooled odds of adenoma recurrence at SC1 with post EMR STSC compared to no STSC was 0.27 (95 % 0.18–0.42; I2 = 0 %), P < 0.001. Pooled rate of adenoma recurrence at SC1 in post EMR STSC cohort was 6 %. Rates of intraprocedural bleeding, delayed bleeding and intraprocedural perforation were 10.3 %, 6.5 % and 2 % respectively. Conclusions Our results show that thermal ablation of resection margins with STSC in LSTs > 20 mm is a safe and effective technique in reducing the incidence of adenoma recurrence.

scholarly journals Underwater versus conventional endoscopic mucosal resection for colorectal lesions: a systematic review and meta-analysis

2020 ◽  
Vol 08 (12) ◽  
pp. E1884-E1894
Author(s):  
Rajat Garg ◽  
Amandeep Singh ◽  
Babu P. Mohan ◽  
Gautam Mankaney ◽  
Miguel Regueiro ◽  
...  
Keyword(s):  
Systematic Review ◽  
Endoscopic Mucosal Resection ◽  
Meta Analysis ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Colorectal Polyps ◽  
Incomplete Resection ◽  
En Bloc ◽  
Delayed Bleeding ◽  
Mucosal Resection

Abstract Background and study aims Underwater endoscopic mucosal resection (UEMR) for colorectal polyps has been reported to have good outcomes in recent studies. We conducted a systematic review and meta-analysis comparing the effectiveness and safety of UEMR to conventional EMR (CEMR). Methods A comprehensive search of multiple databases (through May 2020) was performed to identify studies that reported outcome of UEMR and CEMR for colorectal lesions. Outcomes assessed included incomplete resection, rate of recurrence, en bloc resection, adverse events (AEs) for UEMR and CEMR. Results A total of 1,651 patients with 1,704 polyps were included from nine studies. There was a significantly lower rate of incomplete resection (odds ratio [OR]: 0.19 (95 % confidence interval (CI), 0.05–0.78, P = 0.02) and polyp recurrence (OR: 0.41, 95 % CI, 0.24–0.72, P = 0.002) after UEMR. Compared to CEMR, rates overall complications (relative risk [RR]: 0.66 (95 % CI, 0.48–0.90) (P = 0.008), and intra-procedural bleeding (RR: 0.59, 95 % CI, 0.41–0.84, P = 0.004) were significantly lower with UEMR. The recurrence rate was also lower for large non-pedunculated polyps ≥ 10 mm (OR 0.24, 95 % CI, 0.10–0.57, P = 0.001) and ≥ 20 mm (OR 0.14, 95 % CI, 0.02–0.72, P = 0.01). The rates of en bloc resection, delayed bleeding, perforation and post-polypectomy syndrome were similar in both groups (P > 0.05). Conclusions In this systematic review and meta-analysis, we found that UEMR is more effective and safer than CEMR with lower rates of recurrence and AEs. UEMR use should be encouraged over CEMR.

scholarly journals Underwater vs conventional endoscopic mucosal resection in the management of colorectal polyps: a systematic review and meta-analysis

2020 ◽  
Vol 08 (10) ◽  
pp. E1264-E1272
Author(s):  
Faisal Kamal ◽  
Muhammad Ali Khan ◽  
Wade Lee-Smith ◽  
Zubair Khan ◽  
Sachit Sharma ◽  
...  
Keyword(s):  
Systematic Review ◽  
Endoscopic Mucosal Resection ◽  
Meta Analysis ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Colorectal Polyps ◽  
Complete Resection ◽  
En Bloc ◽  
Mucosal Resection ◽  
Significant Difference

Abstract Background Recently, underwater endoscopic mucosal resection (UEMR) has shown promising results in the management of colorectal polyps. Some studies have shown better outcomes compared to conventional endoscopic mucosal resection (EMR). We conducted this systematic review and meta-analysis to compare UEMR and EMR in the management of colorectal polyps. Methods We searched several databases from inception to November 2019 to identify studies comparing UEMR and EMR. Outcomes assessed included rates of en bloc resection, complete macroscopic resection, recurrent/residual polyps on follow-up colonoscopy, complete resection confirmed by histology and adverse events. Pooled risk ratios (RR) with 95 % confidence interval were calculated using a fixed effect model. Heterogeneity was assessed by I2 statistic. Funnel plots and Egger’s test were used to assess publication bias. We used the Newcastle-Ottawa scale (NOS) for assessment of quality of observational studies, and the Cochrane tool for assessing risk of bias for RCTs Results Seven studies with 1291 patients were included; two were randomized controlled trials and five were observational. UEMR demonstrated statistically significantly better efficacy in rates of en bloc resection, pooled RR 1.16 (1.08, 1.26), complete macroscopic resection, pooled RR 1.28 (1.18, 1.39), recurrent/residual polyps; pooled RR 0.26 (0.12, 0.56) and complete resection confirmed by histology; pooled RR 0.75 (0.57, 0.98). There was no significant difference in adverse events (AEs); pooled RR 0.68 (0.44, 1.05). Conclusions This meta-analysis found statistically significantly better rates of en bloc resection, complete macroscopic resection, and lower risk of recurrent/residual polyps with UEMR compared to EMR. We found no significant difference in AEs between the two techniques.

scholarly journals Efficacy of Underwater Endoscopic Mucosal Resection for Nonpedunculated Colorectal Polyps: A Systematic Review and Meta-Analysis

Cureus ◽  
2021 ◽  
Author(s):  
Takeshi Yamashina ◽  
Noboru Hanaoka ◽  
Takeshi Setoyama ◽  
Jun Watanabe ◽  
Masahiro Banno ◽  
...  
Keyword(s):  
Systematic Review ◽  
Endoscopic Mucosal Resection ◽  
Meta Analysis ◽  
Colorectal Polyps ◽  
Mucosal Resection
Sign in / Sign up

Export Citation Format

Share Document