Feasibility of Underwater Endoscopic Mucosal Resection for Colorectal Lesions: A Single Center Study in Japan

Takuji Kawamura, Hiroaki Sakai, Tomoya Ogawa, Naokuni Sakiyama, Yuki Ueda, Atsushi Shirakawa, Yusuke Okada, Kasumi Sanada, Kojiro Nakase, Koichiro Mandai, Azumi Suzuki, Atsuhiro Morita, Kiyohito Tanaka, Koji Uno, Kenjiro Yasuda


Background: Underwater endoscopic mucosal resection (U-EMR) has emerged as an alternative technique for the resection of colorectal lesions. This study aimed to evaluate our initial experience using U-EMR.

Methods: This is a single-center, retrospective case series study. We analyzed the clinical outcomes of consecutive patients who underwent U-EMR in our endoscopy center, from December 2015 to February 2017.

Results: Our analysis included 64 lesions, contributed by 38 patients, with a mean age of 68.6 years (range, 25 to 90 years). The study sample included 33 right-sided and 25 left-sided colon lesions, and seven rectal lesions, with an average size of 16.2 mm (6 - 40 mm). Of these, 46 lesions were polypoid and 18 ones non-polypoid. Histologically, 31 lesions were low-grade adenomas, eight ones were high-grade adenomas, 11 were mucosal cancers, four were submucosal cancers, and 10 were classified as others. En bloc resection was achieved in 52 (81%) lesions, with an en bloc resection rate of 95% for lesions < 20 mm and 55% for lesions < 20 mm. Complete resection of neoplastic epithelial lesions, defined by a negative pathological margin, was achieved in 32 of 59 neoplastic epithelial lesions (54%). We identified three cases (5%) of post-procedural bleeding and one case of perforation (2%).

Conclusions: U-EMR can be feasibly used for resection of colonic lesions, including lesions >= 20 mm, although the en bloc resection rate for these lesions was lower than for lesions < 20 mm.

Gastroenterol Res. 2018;11(4):274-279
doi: https://doi.org/10.14740/gr1021w


Endoscopic mucosal resection; Colorectal neoplasms; Polyps

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