Randomized Controlled Trial Finds Lower Recurrence Rate With Underwater Versus Conventional Colorectal EMR
Douglas K. Rex, MD, MASGE, reviewing Lenz L, et al. Gastrointest Endosc 2022 Oct 26.
In a randomized controlled trial (RCT) performed in Brazil, 120 colorectal lesions with a mean size of 17.5 mm were randomized to underwater endoscopic mucosal resection (UEMR) versus conventional EMR (CEMR). The groups of patients were similar in demographics and histology, though more lesions were in the proximal colon in the CEMR group (83%) versus the UEMR group (67.8%) (P=.07). There were no complications in either group.
The recurrence rate was higher in the CEMR group (15%) versus in the UEMR group (2%) (P=.03). With 21- to 40-mm lesions, the recurrence rate with CEMR (35.7%) was also higher than with UEMR (0%) (P=.04). There was no difference between groups in the en bloc resection rate (61% with UEMR vs 54% with CEMR).
COMMENTThe most common results of RCTs comparing UEMR versus CEMR have been higher rates of en bloc resection with UEMR, no substantial difference in complication rates, and recurrence rates that sometimes favor UEMR. This trial was performed in the era prior to margin treatment of EMR defects. The recurrence rate in the CEMR group is higher than typical, even without margin treatment. The most important finding is probably the very low recurrence rate in the UEMR group despite the lack of margin treatment. Overall, UEMR has a higher en bloc resection rate, has a low recurrence rate, is very safe, and is very efficient to perform.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Lenz L, Martins B, Andrade de Paulo G, et al. Underwater versus conventional endoscopic mucosal resection for non-pedunculated colorectal lesions: a randomized clinical trial. Gastrointest Endosc 2022 Oct 26. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2022.10.033)
