Modified underwater endoscopic mucosal resection for intermediate-sized sessile colorectal polyps

Area of Science:

• Gastroenterology
• Endoscopy
• Colorectal Surgery

Background:

• Underwater endoscopic mucosal resection (UEMR) is an effective technique for intermediate-sized colorectal polyps.
• Visibility challenges can hinder the effectiveness of standard UEMR procedures.

Purpose of the Study:

• To evaluate a modified UEMR method for improved visibility and resection of intermediate-sized colorectal polyps.
• To assess the efficacy and safety of the modified UEMR technique.

Main Methods:

• A prospective, observational, single-center study involving patients with 10-20 mm sessile colorectal polyps.
• A modified UEMR approach initially snaring the lesion without water, followed by submersion and electrocautery resection.
• Evaluation of complete resection rates (R0) and procedure-related complications.

Main Results:

• The study included 42 patients with 47 polyps, achieving 100% technical success.
• R0 resection rates were 80.9% overall, with higher rates for smaller polyps (<15 mm) compared to larger ones (≥15 mm).
• Immediate bleeding occurred in 12.8% of cases, managed effectively; no delayed bleeding or perforations were reported.

Conclusions:

• The modified UEMR technique offers a viable solution for challenging UEMR cases, particularly when visibility is compromised.
• Careful consideration and technique are necessary when applying this method to polyps exceeding 15 mm.