Safety and efficacy of underwater versus conventional endoscopic mucosal resection for colorectal polyps: Systematic review and meta-analysis of RCTs
Saurabh Chandan, Jay Bapaye, Shahab R. Khan, Babu P. Mohan, Daryl Ramai, Dushyant Singh Dahiya, Mohammad Bilal, Peter V. Draganov, Mohamed O. Othman, Joaquín Rodríguez Sánchez, Gursimran Kochhar
Abstract
Abstract Background and study aims Conventional endoscopic mucosal resection (C-EMR) is limited by low en-bloc resection rates, especially for large (> 20 mm) lesions. Underwater EMR (U-EMR) has emerged as an alternative for colorectal polyps and is being shown to improve en-bloc resection rates. We conducted a systematic review and meta-analysis comparing the two techniques. Methods Multiple databases were searched through November 2022 for randomized controlled trials (RCTs) comparing outcomes of U-EMR and C-EMR for colorectal polyps. Meta-analysis was performed to determine pooled proportions and relative risks (RRs) of R0 and en-bloc resection, polyp recurrence, resection time, and adverse events. Results Seven RCTs with 1458 patients (U-EMR: 739, C-EMR: 719) were included. The pooled rate of en-bloc resection was significantly higher with U-EMR vs C-EMR, 70.17% (confidence interval [CI] 46.68–86.34) vs 58.14% (CI 31.59–80.68), respectively, RR 1.21 (CI 1.01–1.44). R0 resection rates were higher with U-EMR vs C-EMR, 58.1% (CI 29.75–81.9) vs 44.6% (CI 17.4–75.4), RR 1.25 (CI 0.99–1.6). For large polyps (> 20 mm), en-bloc resection rates were comparable between the two techniques, RR 1.24 (CI 0.83–1.84). Resection times were comparable between U-EMR and C-EMR, standardized mean difference –1.21 min (CI –2.57 to –0.16). Overall pooled rates of perforation, and immediate and delayed bleeding were comparable between U-EMR and C-EMR. Pooled rate of polyp recurrence at surveillance colonoscopy was significantly lower with U-EMR than with C-EMR, RR 0.62 (CI 0.41–0.94). Conclusions Colorectal U-EMR results in higher en-bloc resection and lower recurrence rates when compared to C-EMR. Both techniques have comparable resection times and safety profiles.