Abstract
BackgroundUnderwater endoscopic mucosal resection (UEMR) is a recently developed technique and can be performed during water-aided or ordinary colonoscopy for the treatment of colorectal polyps. The objective of this clinical trial was to evaluate the efficacy and safety of UEMR in comparison with conventional endoscopic mucosal resection (CEMR) of small non-pedunculated colorectal polyps.MethodsPatients with small size, non-pedunculated colorectal polyps (4–9 mm in size) who underwent colonoscopic polypectomy were enrolled in this multicenter randomized controlled clinical trial. The patients were randomly allocated to two groups, an UEMR group and a CEMR group. Efficacy and safety were compared between groups.ResultsIn the intention-to-treat (ITT) analysis, the complete resection rate was 83.1% (59/71) in the UEMR group and 87.3% (62/71) in the CEMR group. The en-bloc resection rate was 94.4% (67/71) in the UEMR group and 91.5% (65/71) in the CEMR group (difference 2.9%; 90% CI − 4.2 to 9.9%), showed noninferiority (noninferiority margin − 5.7% < − 4.2%). No significant difference in procedure time (81 s vs. 72 s, P = 0.183) was observed. Early bleeding was observed in 1.4% of patients in the CEMR group (1/71) and 1.4% of patients in the UEMR group (1/71). None of the patients in the UEMR group complained of postprocedural bloody stool, whereas two patients in the CEMR group (2/64) reported this adverse event.ConclusionOur results indicate that UEMR is safer and just as effective as CEMR in En-bloc resection for the treatment of small colorectal polyps as such, UEMR is recommended as an alternative approach to excising small and non-pedunculated colorectal adenomatous polyps.Trial registrationClinical Trials.gov, NCT03833492. Retrospectively registered on February 7, 2019.
Highlights
Underwater endoscopic mucosal resection (UEMR) is a recently developed technique and can be performed during water-aided or ordinary colonoscopy for the treatment of colorectal polyps
Our results indicate that UEMR is safer and just as effective as conventional endoscopic mucosal resection (CEMR) in En-bloc resection for the treatment of small colorectal polyps as such, UEMR is recommended as an alternative approach to excising small and non-pedunculated colorectal adenomatous polyps
Compared with CEMR, UEMR is associated with a higher complete excision rate and lower risk of developing procedurerelated adverse events [9], and it is applied for small colorectal adenomas even in Japan [13]
Summary
Underwater endoscopic mucosal resection (UEMR) is a recently developed technique and can be performed during water-aided or ordinary colonoscopy for the treatment of colorectal polyps. The objective of this clinical trial was to evaluate the efficacy and safety of UEMR in comparison with conventional endoscopic mucosal resection (CEMR) of small non-pedunculated colorectal polyps. It has been well accepted that a majority of CRC cases arise from benign lesions in the colon, mainly colon polyps, and that early removal of colon polyps with endoscopic mucosal resection (EMR) can reduce CRC-related mortality [2] It has been of note in our daily clinical practice that small size colon polyps are very common. There has been no prospective randomized controlled clinical trial to focus on evaluate its efficacy and safety in the resection of small size colorectal polyps
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