Underwater versus conventional endoscopic submucosal dissection for colorectal lesions: systematic review and meta-analysis.

Sudhir Dutta, Sumant Inamdar, Dushyant Singh Dahiya, Neil Sharma, Douglas G Adler, Babu P Mohan, Sahib Singh, Rakesh Vinayek, Vishnu Charan Suresh Kumar, Ganesh Aswath

Journal: Gastrointestinal endoscopy 2025;101(3):551-557.e5

PMID: 39427993

Full Text on Elsevier Science View on PubMed

Abstract

BACKGROUND AND AIMS

Effect of underwater endoscopic submucosal dissection (UESD) on clinical outcomes as compared with conventional ESD (CESD) remains unclear. We conducted a meta-analysis of the available data.

METHODS

Online databases were searched for studies comparing UESD with CESD for colorectal lesions. The outcomes of interest were en-bloc resection, R0 resection, procedure time (minutes), dissection speed (mm/min), and adverse events. Pooled odds ratios (ORs) and standardized mean difference (SMD), along with 95% confidence intervals (CIs) were calculated.

RESULTS

Seven studies with 1401 patients (UESD, 452; CESD, 949) were included. Mean patient age was 69 years, and 57% of patients were men. UESD had both a shorter procedure time (SMD, -1.33; 95% CI, -2.34 to -.32; P = .010) and greater dissection speed (SMD, 1.01; 95% CI, .35-1.68; P = .003) when compared with CESD. No significant differences were observed between the 2 groups with respect to en-bloc resection (OR, 1.13; 95% CI, .37-3.41), R0 resection (OR, 2.36; 95% CI, .79-7.05), delayed bleeding (OR, 1.34; 95% CI, .65-2.74), perforation (OR, 1.13; 95% CI, .64-2.00), and postresection electrocoagulation syndrome (OR, .38; 95% CI, .10-1.42).

CONCLUSIONS

UESD was faster in patients with colorectal lesions but had comparable rates of en-bloc resection, R0 resection, and adverse events when compared with CESD.

Address: Department of Internal Medicine, Sinai Hospital of Baltimore, Baltimore, Maryland, USA.; Department of Gastroenterology & Hepatology, Orlando Gastroenterology PA, Orlando, Florida, USA.; Department of Gastroenterology & Hepatology, Sinai Hospital of Baltimore, Baltimore, Maryland, USA.; Department of Gastroenterology & Hepatology, The University of Kansas School of Medicine, Kansas City, Kansas, USA.; Department of Gastroenterology & Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.; Department of Gastroenterology & Hepatology, Staten Island University Hospital, Staten Island, New York, USA.; Department of Gastroenterology & Hepatology, State University of New York Upstate Medical University, Syracuse, New York, USA.; Department of Gastroenterology & Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA.; Department of Gastroenterology & Hepatology, Centura Health at Porter Adventist Hospital, Denver, Colorado, USA.

DOI: 10.1016/j.gie.2024.10.029