Underwater versus conventional EMR of large nonpedunculated colorectal lesions: a multicenter randomized controlled trial.

Joaquín Rodríguez Sánchez, Marco A Alvarez-Gonzalez, María Pellisé, David Coto-Ugarte, Hugo Uchima, Javier Aranda-Hernández, José Santiago García, José Carlos Marín-Gabriel, Fausto Riu Pons, Oscar Nogales, Ramiro Carreño Macian, Alberto Herreros-de-Tejada, Luis Hernández, G Oliver Patrón, Manuel Rodriguez-Tellez, Eduardo Redondo-Cerezo, Mónica Sánchez Alonso, Maria Daca, Eduardo Valdivielso-Cortazar, Alberto Álvarez Delgado, Mónica Enguita, Sheyla Montori, Eduardo Albéniz

Journal: Gastrointestinal endoscopy 2023;97(5):941-951.e2

PMID: 36572129

Full Text on Elsevier Science View on PubMed

Abstract

BACKGROUND AND AIMS

Underwater EMR (UEMR) is an alternative procedure to conventional EMR (CEMR) to treat large, nonpedunculated colorectal lesions (LNPCLs). In this multicenter, randomized controlled clinical trial, we aimed to compare the efficacy and safety of UEMR versus CEMR on LNPCLs.

METHODS

We conducted a multicenter, randomized controlled clinical trial from February 2018 to February 2020 in 11 hospitals in Spain. A total of 298 patients (311 lesions) were randomized to the UEMR (n = 149) and CEMR (n = 162) groups. The main outcome was the lesion recurrence rate in at least 1 follow-up colonoscopy. Secondary outcomes included technical aspects, en bloc resection rate, R0 resection rates, and adverse events, among others.

RESULTS

There were no differences in the overall recurrence rate (9.5% UEMR vs 11.7% CEMR; absolute risk difference, -2.2%; 95% CI, -9.4 to 4.9). However, considering polyp sizes between 20 and 30 mm, the recurrence rate was lower for UEMR (3.4% UEMR vs 13.1% CEMR; absolute risk difference, -9.7%; 95% CI, -19.4 to 0). The R0 resection showed the same tendency, with significant differences favoring UEMR only for polyps between 20 and 30 mm. Overall, UEMR was faster and easier to perform than CEMR. Importantly, the techniques were equally safe.

CONCLUSIONS

UEMR is a valid alternative to CEMR for treating LNPCLs and could be considered the first option of treatment for lesions between 20 and 30 mm due to its higher en bloc and R0 resection rates. (Clinical trial registration number: NCT03567746.).

Address: Endoscopy Unit, Hospital Universitario 12 de Octubre de Madrid, Madrid, Spain; Hospital General Universitario de Ciudad Real, Ciudad Real, Spain. Electronic address: [email protected].; Department of Digestive Diseases, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.; Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.; Cruces University Hospital Endoscopy Unit Barakaldo, Basque Country, Spain.; Endoscopy Unit, Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain.; Endoscopy Unit, Department of Gastroenterology & Hepatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.; Gastroenterology Department, Research Institute Segovia de Arana, Puerta de Hierro University Hospital, Autonomous University of Madrid, Madrid, Spain.; Endoscopy Unit, Gastroenterology Department, "i+12 Research Institute," Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain.; Gastroenterology Department, Endoscopy Unit, Hospital del Mar, Parc de Salut Mar, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.; Department of Gastroenterology, Hospital San Pedro, Logroño, Spain.; Hospital Santos Reyes, Aranda de Duero, Burgos, Spain.; Hospital Manacor and Hospital Parque Llevant, Palma de Mallorca, Spain.; Digestive Diseases, Virgen Macarena University Hospital, Sevilla, Spain.; Endoscopy Unit, Department of Gastroenterology and Hepatology, "Virgen de Las Nieves" University Hospital, Granada, Spain.; Servicio de Aparato Digestivo, Hospital Santa Bárbara, Puertollano, Spain.; Department of Gastroenterology, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.; Gastroenterologist Department, Salamanca University Hospital, Salamanca, Spain.; Methodology Unit,. Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.; Gastrointestinal Endoscopy Research Unit, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.; Endoscopy Unit, Gastroenterology Department, Hospital Universitario de Navarra (HUN), Navarrabiomed, Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain. Electronic address: [email protected].

DOI: 10.1016/j.gie.2022.12.013

Link outs

Free resources

Medical:

Research Materials:

https://antibodies.cancer.gov/detail/CPTC-NT5E-1

Subscription / membership required

Full Text Sources:

MeSH Terms: Humans, Colorectal Neoplasms, Colonoscopy, Colonic Polyps, Water, Endoscopic Mucosal Resection, Intestinal Mucosa