“Underwater” EMR without submucosal injection for large sessile colorectal polyps (with video) - 21/04/12
Reprint requests: Kenneth F. Binmoeller, MD, Interventional Endoscopy Services, California Pacific Medical Center, 2351 Clay Street, 6th Floor, San Francisco, CA 94115Résumé |
Background |
Submucosal injection is widely performed before EMR of large sessile colorectal polyps to facilitate resection and decrease perforation risk. We developed a novel method of water immersion (“underwater”) EMR (UEMR) that eliminates submucosal injection.
Objective |
To evaluate the feasibility and outcomes of UEMR without submucosal injection for large sessile colorectal polyps.
Design |
Prospective, observational study.
Setting |
Single, tertiary-care referral center.
Intervention |
The standardized EMR technique involves full water immersion for the entire procedure and piecemeal resection with a 15-mm “duck bill” snare.
Main Outcome Measurements |
Complete resection, bleeding, perforation, postpolypectomy syndrome, residual or recurrence adenoma.
Results |
Sixty patients with 62 large sessile colorectal polyps underwent UEMR. The mean/median polyp size was 34/30 mm, and the mean/median resection time was 21/18 minutes. Histology revealed the following: tubular adenoma (n = 22), tubulovillous adenoma (n = 19), villous adenoma (n = 4), serrated adenoma (n = 11), and high-grade dysplasia/carcinoma in situ (n = 6). The mean/median interval until a follow-up colonoscopy in 54 patients (90%) was 20.4/15.2 weeks. One of 54 patients (2%) had an adenoma smaller than 5 mm outside of the postresection scar, consistent with a residual lesion missed on index UEMR.
Complications |
There was no perforation or postpolypectomy syndrome. Delayed bleeding occurred in 3 patients and was managed conservatively.
Limitations |
Limited follow-up; single-center, single-endoscopist, uncontrolled study.
Conclusions |
The underwater resection technique enables complete removal of large sessile colorectal polyps without submucosal injection. The technique was safe in a large patient cohort, and the early recurrence rate appears low. Use of a water interface for UEMR has potential advantages that deserve further study.
Le texte complet de cet article est disponible en PDF.Abbreviations : APC, UEMR
Plan
| DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. |
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| If you would like to chat with an author of this article, you may contact Dr Binmoeller at BinmoeK@sutterhealth.org. |
Vol 75 - N° 5
P. 1086-1091 - mai 2012 Retour au numéro
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