Abstract
Underwater EMR was first described in 2012 by Binmoeller et al 1 Binmoeller K.F. Weilert F. Shah J. et al. "Underwater" EMR without submucosal injection for large sessile colorectal polyps (with video). Gastrointest Endosc. 2012; 75: 1086-1091 Abstract Full Text Full Text PDF PubMed Scopus (176) Google Scholar as a variant of traditional EMR. The main difference is that the buoyancy effect of water immersion on the colonic mucosa eliminates the need for submucosal injection and allows the inclusion of a larger quantity of mucosa within the snare. This approach ultimately confers several a priori advantages over the standard technique. From endoscopists’ perspective, underwater resection can be applied to difficult-to-reach locations such as the appendiceal orifice and diverticular areas. It is also another tool for the treatment of recurrences and fibrotic lesions, improving efficiency (ie, procedural times). From patients’ perspective, the underwater technique appears to achieve better curative (R0) and en bloc resection rates, with safety outcomes (adverse event rate) equivalent to those of the standard technique. 2 Maida M. Sferrazza S. Murino A. et al. Effectiveness and safety of underwater techniques in gastrointestinal endoscopy: a comprehensive review of the literature. Surg Endosc. 2021; 35: 37-51 Crossref PubMed Scopus (3) Google Scholar Efficacy and histologic accuracy of underwater versus conventional endoscopic mucosal resection for large (>20 mm) colorectal polyps: a comparative review and meta-analysisGastrointestinal EndoscopyVol. 94Issue 3PreviewMajor limitations with conventional EMR (C-EMR) include high rates of polyp recurrence and low en-bloc resection rates, especially for lesions >20 mm in size. Underwater EMR (U-EMR) has emerged as an alternate technique for en-bloc resection of larger lesions. We conducted a systematic review and meta-analysis comparing the efficacy and safety of the 2 techniques. Full-Text PDF
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