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Higher rate of en bloc resection with underwater than conventional endoscopic mucosal resection: A meta-analysis.
- Source :
-
Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver [Dig Liver Dis] 2021 Aug; Vol. 53 (8), pp. 958-964. Date of Electronic Publication: 2021 May 29. - Publication Year :
- 2021
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Abstract
- Objectives: Previous meta-analysis including nonrandomized studies showed marginal benefit of underwater endoscopic mucosal resection(U-EMR) compared to conventional EMR(C-EMR) in terms of polypectomy outcomes. We evaluated U-EMR compared to C-EMR in the treatment of colorectal polyps with respect to effectiveness and safety by analyzing only randomized controlled trials(RCTs).<br />Material and Methods: PubMed and Cochrane Library databases were searched for RCTs published until 11/2020, evaluating U-EMR vs. C-EMR regarding en bloc resection, post-endoscopic resection adenoma recurrence, complete resection, adverse events rates and difference in resection time. Abstracts from Digestive Disease Week, United European Gastroenterology Week and ESGE Days meetings were also searched. Effect size on outcomes is presented as risk ratio(RR; 95% confidence interval[CI]) or mean difference(MD; 95%CI). The I <superscript>2</superscript> test was used for quantifying heterogeneity, while Grading of Recommendations Assessment, Development and Evaluation(GRADE) was used to assess strength of evidence.<br />Results: Six RCTs analyzing outcomes from 1157 colorectal polypectomies(U-EMR589;C-EMR,568) were included. U-EMR associated with significant higher rate of en bloc resection compared to C-EMR [RR(95%CI):1.26(1.01-1.58); Chi² for heterogeneity=30.43, P<0.0001; I²=84%, GRADE: Very low]. This effect was more prominent regarding resection of polyps sized ≥20 mm compared to polyps <20 mm [RR(95%CI):1.64(1.22-2.20) vs. 1.10(0.98-1.23)]. Post-resection recurrence [RR(95%CI):0.52(0.28-0.94);GRADE:Low] was lower significantly in U-EMR group. In contrast, no significant difference was detected between U-EMR and C-EMR regarding complete resection [RR(95%CI): 1.06(0.91-1.24) GRADE:Very low] and adverse events occurrence[RR(95%CI):1.00 (0.72-1.39); GRADE:Low].<br />Conclusion: Meta-analysis of RCTs supports that U-EMR resection achieves higher rate of en bloc resection compared to conventional EMR. This effect is driven when resecting large(≥20 mm) polyps.<br /> (Copyright © 2021 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)
Details
- Language :
- English
- ISSN :
- 1878-3562
- Volume :
- 53
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver
- Publication Type :
- Academic Journal
- Accession number :
- 34059445
- Full Text :
- https://doi.org/10.1016/j.dld.2021.05.001