Underwater Techniques in Gastrointestinal Endoscopy: Diving into the Depths

Area of Science:

• Gastroenterology and Endoscopy
• Minimally Invasive Surgery
• Gastrointestinal Oncology

Background:

• Endoscopic resection techniques for gastrointestinal lesions have evolved significantly.
• Underwater endoscopy, introduced in 2012, offers novel approaches to both basic and advanced endoscopic procedures.
• These techniques aim to improve safety and efficacy in resecting various gastrointestinal lesions.

Purpose of the Study:

• To provide a comprehensive update on the current state of underwater endoscopic techniques for gastrointestinal endoscopy.
• To evaluate the feasibility, effectiveness, and safety of underwater basic and advanced endoscopic procedures.
• To assess the role of underwater techniques in managing different types of gastrointestinal lesions.

Main Methods:

• Review of current literature on underwater endoscopic techniques, including underwater endoscopic mucosal resection (U-EMR), endoscopic submucosal dissection (ESD), and peroral endoscopic myotomy (POEM).
• Analysis of data regarding the efficacy and safety of these techniques for various gastrointestinal tract locations (colon, duodenum, esophagus, stomach, ampulla).
• Comparison of underwater techniques with conventional methods, including CO2 insufflation.

Main Results:

• Underwater endoscopic mucosal resection (U-EMR) is effective and safe for colonic lesions >10 mm and recurrent lesions.
• U-EMR is a standard for superficial non-ampullary duodenal tumors (<25 mm).
• Promising feasibility data exist for underwater endoscopic submucosal dissection (U-ESD) and underwater peroral endoscopic myotomy (U-POEM), though further studies are needed.

Conclusions:

• Underwater endoscopic mucosal resection (U-EMR) is established as a standard of care for specific colonic and duodenal lesions.
• Underwater techniques show potential in advanced endoscopic procedures like ESD and POEM.
• Further prospective studies are required to standardize underwater techniques for advanced endoscopic submucosal dissection and peroral endoscopic myotomy.