Underwater Endoscopic Mucosal Resection for 10 mm or Larger Nonpedunculated Colorectal Polyps: A Systematic Review...

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Colorectal Cancer Prevention

Background:

• Underwater endoscopic mucosal resection (UEMR) is increasingly utilized for colorectal polyp removal.
• Favorable outcomes have been reported for UEMR in recent studies.
• Large nonpedunculated polyps (≥10 mm) present unique challenges for endoscopic resection.

Purpose of the Study:

• To evaluate the efficacy and safety of UEMR for nonpedunculated colorectal polyps ≥10 mm.
• To conduct a systematic review and meta-analysis of existing studies on UEMR for large polyps.
• To determine key outcomes including recurrence, resection rates, and adverse events.

Main Methods:

• Comprehensive literature search of multiple databases through May 2020.
• Inclusion of studies reporting UEMR outcomes for nonpedunculated colorectal polyps ≥10 mm.
• Assessment of recurrence rate, en bloc resection, incomplete resection, and adverse events.

Main Results:

• Analysis of 1276 polyps from 16 articles.
• Recurrence rates were 7.3% for polyps ≥10 mm and 5.9% for polyps ≥20 mm.
• En bloc resection rate was 57.7%, R0 resection rate was 58.9%, and incomplete resection rate was 1.5%.
• Pooled adverse events rate was 7.0%, with perforation and postpolypectomy syndrome at 0.8%.

Conclusions:

• UEMR is a safe and effective endoscopic technique for nonpedunculated colorectal polyps ≥10 mm.
• The procedure demonstrates a low recurrence rate, supporting its clinical utility.
• UEMR offers a viable option for managing large colorectal polyps with acceptable safety profiles.