Underwater versus conventional EMR for nonpedunculated colorectal lesions: a randomized clinical trial

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorLENZ, Luciano
dc.contributor.authorMARTINS, Bruno
dc.contributor.authorPAULO, Gustavo Andrade de
dc.contributor.authorKAWAGUTI, Fabio Shiguehissa
dc.contributor.authorBABA, Elisa Ryoka
dc.contributor.authorUEMURA, Ricardo Sato
dc.contributor.authorGUSMON, Carla Cristina
dc.contributor.authorGEIGER, Sebastian Naschold
dc.contributor.authorMOURA, Renata Nobre
dc.contributor.authorPENNACCHI, Caterina
dc.contributor.authorLIMA, Marcelo Simas de
dc.contributor.authorSAFATLE-RIBEIRO, Adriana Vaz
dc.contributor.authorHASHIMOTO, Claudio Lyoiti
dc.contributor.authorRIBEIRO, Ulysses
dc.contributor.authorMALUF-FILHO, Fauze
dc.date.accessioned2023-04-14T17:55:27Z
dc.date.available2023-04-14T17:55:27Z
dc.date.issued2023
dc.description.abstractBackground and aims: Conventional endoscopic mucosal resection (CEMR) is the standard modality for removing nonpedunculated colorectal lesions. Underwater endoscopic mucosal resection (UEMR) has emerged as an alternative method. There are few comparative studies between these techniques, especially evaluating recurrence. Therefore, the purpose of this trial was to compare CEMR and UEMR for the resection of colorectal lesions with respect to efficacy, safety, and recurrence rate. Methods: This was a randomized controlled trial of UEMR versus CEMR for naive and nonpedunculated lesions measuring between 10 and 40 mm. The primary outcome was adenoma recurrence at 6 months after the resec-tion. Secondary outcomes were rates of technical success, en bloc resection, and adverse events. Block random-ization was used to assign patients. Tattooing was performed to facilitate localization of the scars and eventual recurrences. Endoscopic follow-up was scheduled at 6 months after the procedure. The sites of resections were examined with white-light imaging, narrow-band imaging (NBI), and conventional chromoscopy with indigo carmine followed by biopsies. Results: One hundred five patients with 120 lesions were included, with a mean size of 17.5 +/- 7.1 (SD) mm. Sixty-one lesions were resected by UEMR and 59 by CEMR. The groups were similar at baseline regarding age, sex, average size, and histologic type. Lesions in the proximal colon in the CEMR group corresponded to 83% and in the UEMR group to 67.8% (P = .073). There was no difference between groups regarding success rate (1 failure in each group) and en bloc resection rate (60.6% UEMR vs 54.2% CEMR, P = .48). Intraprocedural bleeding was observed in 5 CEMRs (8.5%) and 2 UEMRs (3.3%) (P = .27). There was no perforation or delayed hemorrhage in either groups. Recurrence rate was higher in the CEMR arm (15%) than in the UEMR arm (2%) (P = .031). Therefore, the relative risk of 6-month recurrence rate in the CEMR group was 7.5-fold higher (95% CI, 0.98-58.20), with a number needed to treat of 7.7 (95% CI, 40.33-4.22). The higher recurrence rate in the CEMR group persisted only for lesions measuring 21 to 40 mm (35.7% vs 0%; P = .04). Conclusion: This study demonstrated that UEMR was associated with a lower adenoma recurrence rate than was CEMR. Both endoscopic techniques were effective and had similar rates of adverse events for the treatment of nonpedunculated colorectal lesions. (Gastrointest Endosc 2023;97:549-58.)eng
dc.description.indexMEDLINE
dc.description.indexPubMed
dc.description.indexWoS
dc.description.indexScopus
dc.identifier.citationGASTROINTESTINAL ENDOSCOPY, v.97, n.3, p.549-558, 2023
dc.identifier.doi10.1016/j.gie.2022.10.033
dc.identifier.eissn1097-6779
dc.identifier.issn0016-5107
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/52950
dc.language.isoeng
dc.publisherMOSBY-ELSEVIEReng
dc.relation.ispartofGastrointestinal Endoscopy
dc.rightsrestrictedAccesseng
dc.rights.holderCopyright MOSBY-ELSEVIEReng
dc.subject.otherendoscopic mucosal resectioneng
dc.subject.otherlaterally spreading tumorseng
dc.subject.othersubmucosal injectioneng
dc.subject.othersingle-centereng
dc.subject.otherpolypseng
dc.subject.otherrecurrenceeng
dc.subject.wosGastroenterology & Hepatologyeng
dc.titleUnderwater versus conventional EMR for nonpedunculated colorectal lesions: a randomized clinical trialeng
dc.typearticleeng
dc.type.categoryoriginal articleeng
dc.type.versionpublishedVersioneng
dspace.entity.typePublication
hcfmusp.citation.scopus16
hcfmusp.contributor.author-fmusphcLUCIANO HENRIQUE LENZ TOLENTINO
hcfmusp.contributor.author-fmusphcBRUNO DA COSTA MARTINS
hcfmusp.contributor.author-fmusphcGUSTAVO ANDRADE DE PAULO
hcfmusp.contributor.author-fmusphcFABIO SHIGUEHISSA KAWAGUTI
hcfmusp.contributor.author-fmusphcELISA RYOKA BABA
hcfmusp.contributor.author-fmusphcRICARDO SATO UEMURA
hcfmusp.contributor.author-fmusphcCARLA CRISTINA GUSMON DE OLIVEIRA
hcfmusp.contributor.author-fmusphcSEBASTIAN NASCHOLD GEIGER
hcfmusp.contributor.author-fmusphcRENATA NOBRE MOURA
hcfmusp.contributor.author-fmusphcCATERINA MARIA PIA SIMIONI PENNACCHI
hcfmusp.contributor.author-fmusphcMARCELO SIMAS DE LIMA
hcfmusp.contributor.author-fmusphcADRIANA VAZ SAFATLE RIBEIRO
hcfmusp.contributor.author-fmusphcCLAUDIO LYOITI HASHIMOTO
hcfmusp.contributor.author-fmusphcULYSSES RIBEIRO JUNIOR
hcfmusp.contributor.author-fmusphcFAUZE MALUF FILHO
hcfmusp.description.beginpage549
hcfmusp.description.endpage558
hcfmusp.description.issue3
hcfmusp.description.volume97
hcfmusp.origemWOS
hcfmusp.origem.pubmed36309072
hcfmusp.origem.scopus2-s2.0-85148479880
hcfmusp.origem.wosWOS:000948038600001
hcfmusp.publisher.cityNEW YORKeng
hcfmusp.publisher.countryUSAeng
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