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Underwater endoscopic mucosal resection of colorectal neoplasia is easily learned, efficacious, and safe

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Abstract

Background

Underwater endoscopic mucosal resection (UEMR) without submucosal injection is a novel endoscopic procedure. It is not known if UEMR can be easily taught and learned, and the efficacy and safety of UEMR has not been demonstrated at multiple medical centers. Our aims were to demonstrate that (1) UEMR is a technique that can be easily learned by an endoscopist trained in traditional EMR, (2) endoscopic ultrasound (EUS) may not be required before UEMR, and (3) UEMR is an efficacious and safe method for resection of large or flat neoplastic colorectal lesions.

Methods

An experienced interventional endoscopist began performing UEMR after observing UEMR procedures. Colorectal UEMR was performed using a pediatric colonoscope with a cap, a waterjet, and a ‘duck-bill’ snare using blended current. Submucosal injection was not used. Patient data were collected prospectively.

Results

A total of 21 patients (17 men, mean age 64.9 years, range 51–83) referred for polypectomy of large colorectal lesions underwent UEMR. A total of 43 colorectal lesions with a mean size of 20 mm (range 8–50) were resected by UEMR. Lesions were found in the right colon (N = 16), transverse colon (N = 5), left colon (N = 19), and rectum (N = 3). Pathology demonstrated tubular adenoma (N = 29), tubulovillous adenoma (N = 5), high-grade dysplasia (N = 3), serrated sessile adenoma without dysplasia (N = 3), and non-neoplastic tissue (N = 3). EUS was used in only two cases of rectal neoplasia (4.7 %). Of the UEMRs, 97.7 % were successful with complete resection of colorectal polyps. The only adverse event was one case (2.3 %) of delayed post-UEMR bleeding.

Conclusions

UEMR was easily learned by an endoscopist already skilled in conventional EMR. EUS may not be required prior to most UEMR procedures. UEMR appears to be an efficacious and safe alternative to traditional EMR or ESD for large or flat colorectal neoplasms.

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Abbreviations

EMR:

Endoscopic mucosal resection

ESD:

Endoscopic submucosal dissection

GI:

Gastrointestinal

UEMR:

Underwater endoscopic mucosal resection

EUS:

Endoscopic ultrasound

GEE:

Generalized estimating equation

APC:

Argon plasma coagulation

EPMR:

Endoscopic piecemeal mucosal resection

TA:

Tubular adenoma

NBI:

Narrow-band imaging

TVA:

Tubulovillous adenoma

SSA:

Serrated sessile adenoma

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Acknowledgments

Special thanks to Dr. Kenneth F. Binmoeller for his contributions to the field of endoscopy and for teaching Dr. Wang the UEMR technique.

Disclosures

Andrew Y. Wang, Mary M. Flynn, James T. Patrie, Dawn G. Cox, Wissam Bleibel, James A. Mann, Bryan G. Sauer, Vanessa M. Shami have no conflicts of interest or financial ties to disclose with respect to this manuscript. This work was not supported by any external grants or funding.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, University of Virginia Health System, Box 800708, Charlottesville, VA, 22908, USA

    Andrew Y. Wang, Mary M. Flynn, Dawn G. Cox, Wissam Bleibel, James A. Mann, Bryan G. Sauer & Vanessa M. Shami

  2. Division of Biostatistics and Epidemiology, University of Virginia Health System, Box 800717, Charlottesville, VA, 22908, USA

    James T. Patrie

Authors
  1. Andrew Y. Wang
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  2. Mary M. Flynn
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  3. James T. Patrie
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  4. Dawn G. Cox
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  6. James A. Mann
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  7. Bryan G. Sauer
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  8. Vanessa M. Shami
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Corresponding author

Correspondence to Andrew Y. Wang.

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Wang, A.Y., Flynn, M.M., Patrie, J.T. et al. Underwater endoscopic mucosal resection of colorectal neoplasia is easily learned, efficacious, and safe. Surg Endosc 28, 1348–1354 (2014). https://doi.org/10.1007/s00464-013-3297-5

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  • DOI: https://doi.org/10.1007/s00464-013-3297-5

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