scholarly journals Underwater endoscopic colorectal polyp resection: Feasibility in everyday clinical practice

2017 ◽  
Vol 6 (3) ◽  
pp. 454-462 ◽  
Author(s):  
Sergio Cadoni ◽  
Mauro Liggi ◽  
Paolo Gallittu ◽  
Donatella Mura ◽  
Lorenzo Fuccio ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Endoscopic Mucosal Resection ◽  
Tertiary Care ◽  
Colorectal Polyp ◽  
Routine Clinical Practice ◽  
Colon Polyps ◽  
En Bloc ◽  
Mucosal Resection ◽  
Small Series ◽  
Immediate Bleeding

Background Endoscopic mucosal resection is well-established for resecting flat or sessile benign colon polyps. The novel underwater endoscopic mucosal resection eschews submucosal injection prior to endoscopic mucosal resection. Reports about underwater endoscopic mucosal resection were limited to small series of single and/or tertiary-care referral centers, with single or supervised operators. Objective The purpose of this study was to determine feasibility and efficacy of underwater resection of polyps of any morphology (underwater polypectomy, here includes underwater endoscopic mucosal resection) in routine clinical practice. Methods This study involved a comparison of colonoscopy records of two community hospitals (January 2015–December 2016) for underwater polypectomy ( n = 195) and gas insufflation polypectomy ( n = 186). Results Comparable demographics, procedural data, overall distribution, morphology and size of resected lesions, number of en bloc and R0 resections (any polyp morphology and size); exception: overall, underwater polypectomy pedunculated polyps were significantly larger than those in the gas insufflation polypectomy group, p = 0.030. Underwater polypectomy (median, min) resection time was significantly shorter than gas insufflation polypectomy: sessile and flat polyps 6–9 mm, 0.8 vs 2.7 ( p = 0.040); 10–19 mm, 2.0 vs 3.3 ( p = 0.025), respectively; pedunculated polyps 6–19 mm, 0.8 vs 3.3 ( p < 0.001). Underwater polypectomy resection of pedunculated polyps 6–19 mm showed significantly less immediate bleeding: 11.1% vs 1.5%, respectively ( p = 0.031). Conclusions Underwater polypectomy can be efficaciously used in routine clinical practice for the complete resection of colon polyps, with several advantages over gas insufflation polypectomy.

scholarly journals Is underwater endoscopic mucosal resection of colon polyps superior to conventional techniques? A network analysis of endoscopic mucosal resection and submucosal dissection

2022 ◽  
Vol 10 (01) ◽  
pp. E154-E162
Author(s):  
Choon Seng Chong ◽  
Mark D. Muthiah ◽  
Darren Jun Hao Tan ◽  
Cheng Han Ng ◽  
Xiong Chang Lim ◽  
...  
Keyword(s):  
Endoscopic Mucosal Resection ◽  
Meta Analysis ◽  
Operating Time ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Colon Polyps ◽  
En Bloc ◽  
Oncological Outcomes ◽  
Mucosal Resection ◽  
Submucosal Dissection

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.

scholarly journals A80 ADVANCED ENDOSCOPIC RESECTION OF LARGE POLYPS & EARLY NEOPLASIA: OUTCOMES OF ENDOSCOPIC MUCOSAL RESECTION IN BRITISH COLUMBIA

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 94-95
Author(s):  
B Zhao ◽  
D Chahal ◽  
E Lam ◽  
F Donnellan
Keyword(s):  
British Columbia ◽  
Endoscopic Mucosal Resection ◽  
Endoscopic Resection ◽  
Remission Rate ◽  
Metastatic Cancer ◽  
Colorectal Polyps ◽  
Vancouver General Hospital ◽  
Colon Polyps ◽  
En Bloc ◽  
Mucosal Resection

Abstract Background Recent advances have resulted in a new technique termed endoscopic mucosal resection (EMR). This procedure has been successful at removing large or complex polyps and achieving remission rates comparable to surgery. EMR can also be used to remove early, non-metastatic cancer and they are less invasive than surgery. However, they have been associated with their own complications, most serious of which being perforation. This procedure has recently become available in British Columbia for resection of both complex polyps and early established cancers in the colon. Aims Here we present patient outcomes of EMR procedures for the resection of colorectal polyps in British Columbia. Methods Retrospective data were collected on all EMR procedures done in Vancouver General Hospital and St. Paul’s Hospital (Vancouver, B.C.) from October 2012 (when procedure became available) to July 2019. Inclusion criteria were all adults who had undergone EMR for resection of polyps in the colon. Exclusion criteria were patients younger than 18 or patients who had EMR that resected polyps in the upper GI tract. Patients were referred to one of two endoscopists when one or more polyps suitable for EMR were identified during colonoscopy by other gastroenterologists. Collected data included patient demographics, polyp characteristics, procedure outcome, and complications. Results There were 211 EMR procedures performed on 182 patients (48.9% male). Patient age ranged from 27 to 86 (mean = 67.1). A total of 244 colon polyps were removed with an average size of 2.91 cm and ranged from 0.8 cm to 15 cm. Resected polyps had the following distribution: ascending colon (63.5%), transverse colon (10.2%), descending colon (5.7%), sigmoid colon (15.2%), and rectum (5.3%). Of those that reported resection type, 84.2% were piecemeal and 15.8% were en bloc. 40.9% of polyps were tubulovillous adenoma, 33.2% were tubular, 16.2% were sessile serrated, 6.4% were villous, and 3.4% were adenocarcinoma. Patients from 11 of the 211 EMR cases (5.2%) experienced post-procedure bleed and 4 of these 11 patients (36.4%) had been on anti-platelet or anti-coagulants (discontinued before procedure). Overall, patients from 51 (24.2%) EMR cases were on anti-platelet or anti-coagulants. 33 cases (15.6%) had residual polyps at the resection site that required additional endoscopic resection during follow-up and 14 patients (6.6%) required surgery. None of the EMR procedures resulted in perforation. Conclusions EMR is an effective minimally-invasive procedures that can be used to remove large, complicated colonic polyps and achieve long-term remission rate. The procedure has an acceptable risk profile, with complication and re-intervention rate similar or less than other procedures used to remove large, complicated polyps. Funding Agencies None

scholarly journals Endoscopic mucosal resection of early gastric cancer: initial experience with two technical variants

2007 ◽  
Vol 44 (3) ◽  
pp. 250-256 ◽  
Author(s):  
Paulo Moacir de Oliveira Campoli ◽  
Flávio Hayato Ejima ◽  
Daniela Medeiros Milhomem Cardoso ◽  
Eliane Duarte Mota ◽  
Ailton Cabral Fraga Jr. ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Early Gastric Cancer ◽  
Endoscopic Mucosal Resection ◽  
Endoscopic Treatment ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Lymphatic Invasion ◽  
En Bloc ◽  
Mucosal Resection ◽  
Small Series

BACKGROUND: When performed in carefully selected cases, the endoscopic treatment of early gastric cancer yields results which are comparable to the conventional surgical treatment, but with lower morbidity and mortality and better quality of life. Several technical options to perform endoscopic mucosal resection have been described and there is a large amount of accumulated experience with this procedure in eastern countries. In western countries, particularly in Brazil, technical limitations associated with the small number of cases of early gastric cancer reflect the little experience with this therapeutic mode. AIM: This study was carried out in order to assess the indications, pathological results and morbidity of a series of endoscopic mucosal resections using two technical variants in addition to investigating the safety and feasibility of the method. METHODS: Individuals with well-differentiated early gastric adenocarcinomas with up to 30 mm in diameter without scar or ulcer underwent endoscopic treatment. Two variants of the strip biopsy technique were used. The pathological study assessed the depth of the vertical invasion, lateral and basal margins as well as angio-lymphatic invasion. RESULTS: Thirteen tumors in 12 patients were resected between June 2002 and August 2005. The most common macroscopic types were IIa and IIa + IIc. Tumor size ranged from 10 to 30 mm (mean = 16.5 mm). En bloc resection was carried out in nine patients. Angio-lymphatic invasion was not observed; however, submucosal invasion was found in two cases. In four cases, the lateral margin was involved. Perforation occurred in two patients who then received conservative treatment. CONCLUSION: The relatively small series presented here suggests that the method is safe and feasible. Appropriate patient selection is the most important criteria. Long follow-up is required after treatment due to the risk of relapse.

scholarly journals Efficacy and safety of cap-assisted endoscopic mucosal resection of ileocecal valve polyps

2020 ◽  
Vol 08 (03) ◽  
pp. E241-E246
Author(s):  
Daniel Lew ◽  
Amir Kashani ◽  
Simon K. Lo ◽  
Laith H. Jamil
Keyword(s):  
Endoscopic Mucosal Resection ◽  
Care Center ◽  
Tertiary Care ◽  
Ileocecal Valve ◽  
Efficacy And Safety ◽  
Polyp Size ◽  
En Bloc ◽  
Negative Biopsy ◽  
Mucosal Resection

Abstract Background and study aims Standard endoscopic mucosal resection (EMR) of ileocecal valve (ICV) polyps is challenging. Cap-assisted endoscopic mucosal resection (C-EMR) can be performed when polyps are not easily amenable to standard EMR. Current literature is limited regarding its efficacy and safety for ICV polyps. The objectives of this study were to assess the efficacy and safety of C-EMR for ICV polyps. Patients and methods A retrospective review was conducted from September 2008 to November 2018 at a tertiary care center. Patients included in the study underwent C-EMR for ICV polyps by a single gastroenterologist (LHJ). Polyps were successfully eradicated if they were removed en-bloc as confirmed by pathology, or had a negative biopsy on follow-up colonoscopy. Outcomes of the procedures were evaluated, including complete adenoma clearance and adverse events. Results Twenty-one ICV polyps were removed with C-EMR. Median polyp size was 15 mm (range, 5–45). The rate of complete adenoma clearance was 100 %. Procedure-related complications occurred in five patients (24 %): delayed GI bleeding (4.8 %) and deep mucosal resection/visible vessel (14.3 %). Three patients had subsequent surveillance colonoscopies at 8, 56, and 67 months, respectively. The third patient was found to have a 6-mm flat polyp at the edge of the previous polypectomy site. This was treated with C-EMR and repeat colonoscopy 6 months later did not show residual. Conclusion C-EMR is highly effective in treating ICV polyps with a low complication rate. It is our suggested method in approaching ICV polyps that are difficult to remove via standard freehand snare EMR technique.

scholarly journals Clip placement to prevent delayed bleeding after colonic endoscopic mucosal resection (CLIPPER): study protocol for a randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ayla S. Turan ◽  
◽  
Leon M. G. Moons ◽  
Ramon-Michel Schreuder ◽  
Erik J. Schoon ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
The Netherlands ◽  
Endoscopic Mucosal Resection ◽  
Intervention Group ◽  
Proximal Colon ◽  
Control Group ◽  
Colon Polyps ◽  
Delayed Bleeding ◽  
Randomized Controlled ◽  
Mucosal Resection

Abstract Background Endoscopic mucosal resection (EMR) for large colorectal polyps is in most cases the preferred treatment to prevent progression to colorectal carcinoma. The most common complication after EMR is delayed bleeding, occurring in 7% overall and in approximately 10% of polyps ≥ 2 cm in the proximal colon. Previous research has suggested that prophylactic clipping of the mucosal defect after EMR may reduce the incidence of delayed bleeding in polyps with a high bleeding risk. Methods The CLIPPER trial is a multicenter, parallel-group, single blinded, randomized controlled superiority study. A total of 356 patients undergoing EMR for large (≥ 2 cm) non-pedunculated polyps in the proximal colon will be included and randomized to the clip group or the control group. Prophylactic clipping will be performed in the intervention group to close the resection defect after the EMR with a distance of < 1 cm between the clips. Primary outcome is delayed bleeding within 30 days after EMR. Secondary outcomes are recurrent or residual polyps and clip artifacts during surveillance colonoscopy after 6 months, as well as cost-effectiveness of prophylactic clipping and severity of delayed bleeding. Discussion The CLIPPER trial is a pragmatic study performed in the Netherlands and is powered to determine the real-time efficacy and cost-effectiveness of prophylactic clipping after EMR of proximal colon polyps ≥ 2 cm in the Netherlands. This study will also generate new data on the achievability of complete closure and the effects of clip placement on scar surveillance after EMR, in order to further promote the debate on the role of prophylactic clipping in everyday clinical practice. Trial registration ClinicalTrials.gov NCT03309683. Registered on 13 October 2017. Start recruitment: 05 March 2018. Planned completion of recruitment: 31 August 2021.

scholarly journals Underwater endoscopic mucosal resection for en bloc resection of a neuroendocrine tumor in the duodenal bulb

Endoscopy ◽  
2021 ◽  
Author(s):  
Hugo Uchima ◽  
Alberto Diez-Caballero ◽  
Jaume Capdevila ◽  
Mercé Rosinach ◽  
Alfredo Mata ◽  
...  
Keyword(s):  
Neuroendocrine Tumor ◽  
Endoscopic Mucosal Resection ◽  
Duodenal Bulb ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Mucosal Resection

Current Endoscopic Resection Techniques for Gastrointestinal Lesions: Endoscopic Mucosal Resection, Submucosal Dissection, and Full-Thickness Resection

2021 ◽  
pp. 1-14
Author(s):  
Arthur Hoffman ◽  
Raja Atreya ◽  
Timo Rath ◽  
Markus Ferdinand Neurath
Keyword(s):  
Endoscopic Mucosal Resection ◽  
Endoscopic Resection ◽  
Complication Rates ◽  
Full Thickness ◽  
National Guidelines ◽  
En Bloc ◽  
Early Stages ◽  
Mucosal Resection ◽  
Submucosal Dissection ◽  
Gastrointestinal Lesions

<b><i>Background:</i></b> Endoscopic resection of dysplastic lesions in early stages of cancer reduces mortality rates and is recommended by many national guidelines throughout the world. Snare polypectomy and endoscopic mucosal resection (EMR) are established techniques of polyp removal. The advantages of these methods are their relatively short procedure times and acceptable complication rates. The latter include delayed bleeding in 0.9% and a perforation risk of 0.4–1.3%, depending on the size and location of the resected lesion. EMR is a recent modification of endoscopic resection. A limited number of studies suggest that larger lesions can be removed en bloc with low complication rates and short procedure times. Novel techniques such as endoscopic submucosal dissection (ESD) are used to enhance en bloc resection rates for larger, flat, or sessile lesions. Endoscopic full-thickness resection (EFTR) is employed for non-lifting lesions or those not easily amenable to resection. Procedures such as ESD or EFTR are emerging standards for lesions inaccessible to EMR techniques. <b><i>Summary:</i></b> Endoscopic treatment is now regarded as first-line therapy for benign lesions. <b><i>Key Message:</i></b> Endoscopic resection of dysplastic lesions or early stages of cancer is recommended. A plethora of different techniques can be used dependent on the lesions.

Higher rate of en bloc resection with underwater than conventional endoscopic mucosal resection: A meta-analysis

2021 ◽  
Author(s):  
Georgios Tziatzios ◽  
Paraskevas Gkolfakis ◽  
Konstantinos Triantafyllou ◽  
Lorenzo Fuccio ◽  
Antonio Facciorusso ◽  
...  
Keyword(s):  
Endoscopic Mucosal Resection ◽  
Meta Analysis ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Mucosal Resection
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