Underwater Endoscopic Mucosal Resection Is a Technique with a Short Learning Curve: A Multicentric Prospective Study

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Medical Education

Background:

• Underwater endoscopic mucosal resection (U-EMR) offers a promising alternative for resecting large colorectal polyps compared to conventional EMR.
• A significant gap exists in understanding the learning curve associated with U-EMR for endoscopists.
• This study addresses the need to evaluate the proficiency acquisition for U-EMR.

Purpose of the Study:

• To determine the learning curve of U-EMR in endoscopists with no prior experience in this technique.
• To assess the number of procedures required to achieve proficiency in U-EMR.
• To evaluate key performance indicators such as technical success, en bloc resection rates, procedural time, and adverse events.

Main Methods:

• Four endoscopists performed U-EMR on patients with colorectal lesions (10-30 mm) after standardized online training.
• Data on technical success, en bloc resection rates, procedural time, and adverse events were collected.
• Outcomes were analyzed across different procedural phases (pre- and post-10/15 procedures) to identify proficiency thresholds.

Main Results:

• A total of 84 lesions were resected with a high en bloc resection rate (85%) and complete resection in all cases.
• Mean procedural time was 3.99 minutes, with no significant improvements observed after the 16th procedure.
• No major adverse events like perforations or delayed bleeding occurred; intraprocedural bleeding was managed conservatively.

Conclusions:

• U-EMR is a safe, efficient, and readily adoptable endoscopic technique.
• Proficiency in U-EMR can be achieved relatively quickly, suggesting a short learning curve.
• The findings support U-EMR as a viable option for large colorectal polyp resection.