Sandhu Dalbir S, Lee Ye J, Gerke Henning
Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA -
Division of Gastroenterology and Hepatology, University of Iowa Hospital and Clinics, Iowa City, IA, USA -
Minerva Gastroenterol Dietol. 2018 Jun;64(2):106-110. doi: 10.23736/S1121-421X.17.02444-8. Epub 2017 Oct 9.
Large sessile/flat colonic polyps are traditionally removed by lift polypectomy. Underwater endoscopic mucosal resection (UEMR) is a novel technique where air is suctioned out and replaced by water to decompress the colon so that the flat lesions assumes a more polypoid shape facilitating its removal with the standard snare resection. We report the feasibility and safety in our series of patients utilizing this technique.
A retrospective, observational study of all patients who underwent removal of large colonic polyps (>10 mm) over a period of 3 years (January 2012 to January 2015) at a tertiary care center by UEMR were included in the study.
A total of 102 polyps were removed in 93 adult patients using UEMR. The mean age of patients was 64.7±9.7 years. The average number of polyps per patient was 1.84±1.3 with a range of 1-7. The range of the polyp size was 10 to 60 mm. The mean size of the polyp was 20.4±9.4 mm, median size 26.9±9.4 mm. Ninety-two (90.2%) were removed in piecemeal fashion and ten (9.8%) were removed en bloc. Delayed bleeding occurred in seven (9.7%) patients.
In this largest series on UEMR, we report the feasibility and safety of this procedure. Future randomized trials comparing this technique versus standard lift polypectomy technique will further elucidate the benefit of one over other.
大型无蒂/扁平结肠息肉传统上通过抬举式息肉切除术切除。水下内镜黏膜切除术（UEMR）是一种新技术，即吸出空气并用水替代以对结肠进行减压，使扁平病变呈现更息肉样的形状，便于用标准圈套器切除术将其切除。我们报告了在我们的一系列患者中使用该技术的可行性和安全性。
本研究纳入了一家三级医疗中心在3年期间（2012年1月至2015年1月）通过UEMR切除大型结肠息肉（>10 mm）的所有患者的回顾性观察研究。
93例成年患者使用UEMR共切除102枚息肉。患者的平均年龄为64.7±9.7岁。每位患者息肉的平均数量为1.84±1.3枚，范围为1 - 7枚。息肉大小范围为10至60 mm。息肉的平均大小为20.4±9.4 mm，中位数大小为26.9±9.4 mm。92枚（90.2%）息肉采用分块切除，10枚（9.8%）息肉整块切除。7例（9.7%）患者发生延迟性出血。
在关于UEMR的这个最大系列研究中，我们报告了该手术的可行性和安全性。未来比较该技术与标准抬举式息肉切除术技术的随机试验将进一步阐明哪种技术更具优势。
