Efficacy and histologic accuracy of underwater versus conventional endoscopic mucosal resection for large (20 mm) colorectal polyps: a comparative review and meta-analysis
| Autor: | Saurabh Chandan, Daryl Ramai, Gursimran Kochhar, Mohamed O. Othman, Anand Kumar, Shahab R. Khan, Peter V. Draganov, Babu P. Mohan, Lena L. Kassab |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Endoscopic Mucosal Resection Colorectal cancer Colonic Polyps Endoscopic mucosal resection digestive system law.invention 03 medical and health sciences 0302 clinical medicine Text mining Randomized controlled trial law health services administration medicine Humans Radiology Nuclear Medicine and imaging Intestinal Mucosa Adverse effect Randomized Controlled Trials as Topic business.industry Gastroenterology Odds ratio Colonoscopy medicine.disease Confidence interval surgical procedures operative 030220 oncology & carcinogenesis Meta-analysis 030211 gastroenterology & hepatology Radiology Neoplasm Recurrence Local business Colorectal Neoplasms |
| Zdroj: | Gastrointestinal endoscopy. 94(3) |
| ISSN: | 1097-6779 |
| Popis: | Background and Aims Major limitations with conventional EMR (C-EMR) include high rates of polyp recurrence and low en-bloc resection rates, especially for lesions >20 mm in size. Underwater EMR (U-EMR) has emerged as an alternate technique for en-bloc resection of larger lesions. We conducted a systematic review and meta-analysis comparing the efficacy and safety of the 2 techniques. Methods Multiple databases were searched through June 2020 for studies that compared outcomes of U-EMR and C-EMR for colorectal lesions. Meta-analysis was performed to determine pooled odds ratios (ORs) of successful R0, en-bloc, and piecemeal resection of colorectal lesions. We compared the rates of polyp recurrence at follow-up, diagnostic accuracy for colorectal cancer, and adverse events with the 2 techniques. Results Eleven studies, including 4 randomized controlled trials (RCTs) with 1851 patients were included in the final analysis. A total of 1071 lesions were removed using U-EMR, and 1049 lesions were removed using C-EMR. Although U-EMR had an overall superior en-bloc resection rate compared with C-EMR (OR, 1.9; 95% confidence interval [CI], 1-3.5; P = .04), both techniques were comparable in terms of polyps >20 mm in size (OR, 0.8; 95% CI, 0.3-2.1; P = .75), R0 resection (OR, 3.1; 95% CI, 0.74-12.6; P = .14), piecemeal resection (OR, 3.1; 95% CI, 0.74-12.6; P = .13), and diagnostic accuracy for colorectal cancer (OR, 1.1; 95% CI, 0.6-1.8; P = .82). There were lower rates of polyp recurrence (OR, 0.3; 95% CI, 0.1-0.8; P = .01) and incomplete resection (OR, 0.4; 95% CI, 0.2-0.5; P = .001) with U-EMR. Both techniques have comparable resection times and safety profiles. Conclusions Our results support the use of U-EMR over C-EMR for successful resection of colorectal lesions. Further randomized controlled trials are needed to evaluate the efficacy of U-EMR for resecting polyps >20 mm in size. |
| Databáze: | OpenAIRE |
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