A Step-Up Underwater Endoscopic Mucosal Resection Strategy with Rescue Underwater Injection Endoscopic Mucosal...

Area of Science:

• Gastroenterology
• Endoscopy
• Colorectal Surgery

Background:

• Underwater endoscopic mucosal resection (UEMR) is effective for non-pedunculated colorectal lesions.
• Challenges in UEMR include visualization and snare stability, potentially compromising resection margins.
• A step-up strategy offers a potential solution to these limitations.

Purpose of the Study:

• To evaluate the technical outcomes and safety of a step-up strategy for treating non-pedunculated colorectal lesions.
• The strategy involves initial UEMR with selective conversion to underwater injection EMR (UIEMR).
• Focus on lesions measuring 10-20 mm.

Main Methods:

• Retrospective, single-center study of 56 non-pedunculated colorectal lesions (10-20 mm).
• Lesions were initially treated with UEMR.
• Conversion to UIEMR was performed based on predefined intra-procedural criteria indicating UEMR difficulty.

Main Results:

• The step-up strategy was applied to 56 lesions, with 31 treated by UEMR alone and 25 requiring conversion to UIEMR.
• En bloc resection was achieved in all cases.
• Histologically negative resection margins (R0) were obtained in all lesions, with no observed delayed bleeding or perforation.

Conclusions:

• The step-up strategy combining UEMR and selective UIEMR is a feasible and safe treatment option for 10-20 mm non-pedunculated colorectal lesions.
• This approach addresses UEMR limitations and ensures complete resection.
• It represents a practical advancement in endoscopic colorectal lesion management.