Clin Endosc.  2021 May;54(3):379-389. 10.5946/ce.2020.276.

Underwater Endoscopic Mucosal Resection for 10 mm or Larger Nonpedunculated Colorectal Polyps: A Systematic Review and Meta-Analysis

• Garg R
• Singh A
• Aggarwal M
• Bhalla J
• Mohan BP
• Burke C
• Rustagi T
• Chahal P

• KMID: 2516318
• DOI: http://doi.org/10.5946/ce.2020.276

Abstract

Background/Aims
Recent studies have reported the favorable outcomes of underwater endoscopic mucosal resection (UEMR) for colorectal polyps. We performed a systematic review and meta-analysis evaluating the efficacy and safety of UEMR for nonpedunculated polyps ≥10 mm.
Methods
We performed a comprehensive search of multiple databases (through May 2020) to identify studies reporting the outcomes of UEMR for ≥10 mm nonpedunculated colorectal polyps. The assessed outcomes were recurrence rate on the first follow-up, en bloc resection, incomplete resection, and adverse events after UEMR.
Results
A total of 1276 polyps from 16 articles were included in our study. The recurrence rate was 7.3% (95% confidence interval [CI], 4.3–12) and 5.9% (95% CI, 3.6–9.4) for nonpedunculated polyps ≥10 and ≥20 mm, respectively. For nonpedunculated polyps ≥10 mm, the en bloc resection, R0 resection, and incomplete resection rates were 57.7% (95% CI, 42.4–71.6), 58.9% (95% CI, 42.4–73.6), and 1.5% (95% CI, 0.8–2.6), respectively. The rates of pooled adverse events, intraprocedural bleeding, and delayed bleeding were 7.0%, 5.4%, and 2.9%, respectively. The rate of perforation and postpolypectomy syndrome was 0.8%.
Conclusions
Our systematic review and meta-analysis demonstrates that UEMR for nonpedunculated colorectal polyps ≥10 mm is safe and effective with a low rate of recurrence.

Keyword

Underwater, Colorectal; EMR; Polyps; Resection

Figure

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  Fig. 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram showing the search strategy for meta-analysis. CI, confidence interval.

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  Fig. 2. Nonpedunculated polyps ≥10 mm after underwater endoscopic mucosal resection. (A) Forest plot showing the pooled rates of recurrence. (B) En bloc resection. (C) R0 resection. (D) Incomplete resection. CI, confidence interval.

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  Fig. 3. Underwater endoscopic mucosal resection for nonpedunculated polyps ≥10 mm. (A) Forest plot showing the rates of adverse events. (B) Intraprocedural bleeding. (C) Delayed bleeding. (D) Perforation.

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  Fig. 4. Funnel plot assessing publication bias with filled studies.

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