Journal
JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY
Volume 36, Issue 9, Pages 2549-2557Publisher
WILEY
DOI: 10.1111/jgh.15494
Keywords
colorectal polyp; endoscopic submucosal dissection; local recurrence rate; propensity score matching; underwater endoscopic mucosal resection
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In treating 20-30 mm colorectal lesions, underwater endoscopic mucosal resection (UEMR) showed comparable long-term outcomes with endoscopic submucosal dissection (ESD), with a shorter procedure time but lower en bloc resection rate.
Background and Aim Endoscopic submucosal dissection (ESD) for large polyps provides a high en bloc resection rate, accurate pathological diagnosis, and low recurrence rate. However, ESD requires advanced techniques, and underwater endoscopic mucosal resection (UEMR) is an alternative. We investigated the efficacy and safety of UEMR for 20-30 mm colorectal lesions compared with ESD. Methods We retrospectively evaluated systematically collected data of patients who underwent UEMR or ESD for 20-30 mm sessile colorectal lesions. Outcome measures were the incidence of local recurrence, procedure time, en bloc resection rate, and incidence of adverse events. We performed propensity score matching and inverse probability weighting adjustment to control for possible confounders. Results We evaluated 125 patients undergoing UEMR and 306 patients undergoing ESD. Using propensity score matching, we analyzed 74 lesions in each group. UEMR had a shorter procedure time than ESD [6.7 min (95% confidence interval (CI), 5.3-8.1 min) vs 64.8 min (95% CI, 57.4-72.2 min), respectively]. Although the en bloc resection rate with UEMR was inferior to ESD [61% (95% CI, 49-72%) vs 99% (95% CI, 93-100%), respectively], there was no significant difference in the local recurrence rate between the procedures [0% (95% CI, 0-4.0%) in each group]. Inverse probability weighting adjustment revealed that neither ESD nor UEMR had a significant association with local recurrence. Conclusions Underwater endoscopic mucosal resection for 20-30 mm colorectal lesions was comparable with ESD regarding long-term outcomes, with a shorter procedure time, despite the lower en bloc resection rate.
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