Abstract
Background and Aims
Underwater endoscopic mucosal resection (UEMR) is an emerging technique for endoscopic
resection of superficial non-ampullary duodenal epithelial tumors (SNADETs). However,
compared to conventional EMR, its efficacy and safety has not been widely explored.
Methods
We conducted a comprehensive search using the Pubmed, Embase, and Cochrane Library
databases to identify studies comparing the efficacy and safety of UEMR versus EMR
for SNADETs. The main outcomes examined included en bloc resection rate, R0 resection
rate, recurrence rate, procedure time, and adverse events.
Results
A total of 5 studies comprising 635 patients were included. All the literature included
duodenal lesions smaller than 20 mm. The pooled analysis showed that UEMR could achieve
a higher en bloc resection rate (OR 1.78, 95%CI: 1.17 to 2.71, P = 0.007) and shorter procedure time (MD -4.08, 95%CI: -6.44 to -1.73, P = 0.0007) than EMR. However, the pooled results did not support a superiority of
UEMR over EMR for R0 resection rate (OR 1.27; 95% CI: 0.90 to 1.81, P = 0.18) or recurrence rate (OR 0.49; 95% CI: 0.15 to 1.67, P = 0.26). The occurrence of adverse events, including postoperative bleeding, intraoperative
perforation, and delayed perforation, was very low in included studies.
Conclusion
Compared to EMR, UEMR is an effective and safe technique for SNADETs ≤20 mm.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Digestive and Liver DiseaseAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
JM Jepsen, Persson M, Jakobsen NO, et al. Prospective study of prevalence and endoscopic and histopathologic characteristics of duodenal polyps in patients submitted to upper endoscopy. Scand. J. Gastroenterol. 1994; 29: 483–7.
- Endoscopic diagnosis of superficial non-ampullary duodenal epithelial tumors in Japan: multicenter case series.Dig. Endosc. 2014; 26: 23-29
- Current status of endoscopic resection for superficial nonampullary duodenal epithelial tumors.Digestion. 2018; 97: 45-51
- Endoscopic mucosal resection vs endoscopic submucosal dissection for superficial non-ampullary duodenal tumors.World. J. Gastrointest. Oncol. 2020; 12: 918-930
- Endoscopic submucosal dissection and endoscopic mucosal resection for non-ampullary superficial duodenal tumor.Digestion. 2017; 95: 36-42
- Underwater" EMR without submucosal injection for large sessile colorectal polyps (with video).Gastrointest. Endosc. 2012; 75: 1086-1091
- Underwater versus conventional EMR for colorectal polyps: systematic review and meta-analysis.Gastrointest. Endosc. 2021; 93: 378-389
- Underwater EMR for colorectal lesions: a systematic review with meta-analysis (with video).Gastrointest. Endosc. 2019; 89 (e4): 1109-1116
- The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.PLoS Med. 2009; 6e1000100
- Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses.Eur. J. Epidemiol. 2010; 25: 603-605
- Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range.BMC Med. Res. Methodol. 2014; 14: 135
- Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range.Stat. Methods Med. Res. 2018; 27: 1785-1805
- Measuring inconsistency in meta-analyses.BMJ. 2003; 327: 557-560
- Feasibility study comparing underwater endoscopic mucosal resection and conventional endoscopic mucosal resection for superficial non-ampullary duodenal epithelial tumor < 20mm.Dig. Endosc. 2020; 32: 753-760
- Appropriate endoscopic treatment selection and surveillance for superficial non-ampullary duodenal epithelial tumors.Scand. J. Gastroenterol. 2021; 56: 342-350
- Efficacy of underwater endoscopic mucosal resection for superficial non-ampullary duodenal epithelial tumor.Clin. Endosc. 2021; 54: 371-378
- Utility of underwater EMR for nonpolypoid superficial nonampullary duodenal epithelial tumors ≤20mm.Gastrointest. Endosc. 2022; 95: 140-148
- Resectability of underwater endoscopic mucosal resection for duodenal tumor: a single-center, retrospective pilot study.J. Gastroenterol. Hepatol. 2021; 36: 3191-3195
- The resection capability of conventional EMR versus underwater EMR in the treatment of superficial duodenal epithelial tumor.J. Gastroenterol. Hepatol. 2018; 33: AB199
- Appropriate selection of endoscopic resection for superficial nonampullary duodenal adenomas in association with recurrence.Gastrointest. Endosc. 2022; 95: 939-947
- Underwater endoscopic mucosal resection (EMR) appears safe and efficacious compared to conventional EMR for the removal of duodenal adenomas.Gastrointest. Endosc. 2017; 85: AB298
- Outcomes of endoscopic resection for superficial duodenal tumors: 10 years' experience in 18 Japanese high volume centers.Endoscopy. 2022; 54: 663-670
- Cochrane handbook for systematic reviews of interventions.2nd Edition. John Wiley & Sons, ChichesterUK2019
- Approach to the endoscopic resection of duodenal lesions.World J. Gastroenterol. 2016; 22: 600-617
- Endoscopic management of superficial nonampullary duodenal tumors: European society of gastrointestinal endoscopy (ESGE) guideline.Endoscopy. 2021; 53: 522-534
- Underwater endoscopic mucosal resection.Gastrointest. Endosc. Clin. N Am. 2019; 29: 659-673
- Higher rate of en bloc resection with underwater than conventional endoscopic mucosal resection: a meta-analysis.Dig. Liver Dis. 2021; 53: 958-964
- Efficacy and histologic accuracy of underwater versus conventional endoscopic mucosal resection for large (>20mm) colorectal polyps: a comparative review and meta-analysis.Gastrointest. Endosc. 2021; 94 (e9): 471-482
- Nonrecurrence rate of underwater EMR for ≤20-mm nonampullary duodenal adenomas: a multicenter prospective study (D-UEMR Study).Clin. Gastroenterol. Hepatol. 2021; https://doi.org/10.1016/j.cgh.202 1.06.043
- Underwater vs conventional endoscopic mucosal resection of large sessile or flat colorectal polyps: a prospective randomized controlled trial.Gastroenterology. 2021; 161 (e1): 1460-1474
Article info
Publication history
Published online: October 01, 2022
Accepted:
September 7,
2022
Received:
December 17,
2021
Editor: Roberto de FranchisPublication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.