Kamal Faisal, Khan Muhammad Ali, Lee-Smith Wade, Khan Zubair, Sharma Sachit, Tombazzi Claudio, Ahmad Dina, Ismail Mohammad Kashif, Howden Colin W, Binmoeller Kenneth F
Division of Gastroenterology, University of Tennessee Health Science Center, Memphis, Tennessee, United States.
Division of Gastroenterology, University of Alabama at Birmingham, Birmingham, Alabama, United States.
Endosc Int Open. 2020 Oct;8(10):E1264-E1272. doi: 10.1055/a-1214-5692. Epub 2020 Sep 22.
Recently, underwater endoscopic mucosal resection (UEMR) has shown promising results in the management of colorectal polyps. Some studies have shown better outcomes compared to conventional endoscopic mucosal resection (EMR). We conducted this systematic review and meta-analysis to compare UEMR and EMR in the management of colorectal polyps. We searched several databases from inception to November 2019 to identify studies comparing UEMR and EMR. Outcomes assessed included rates of en bloc resection, complete macroscopic resection, recurrent/residual polyps on follow-up colonoscopy, complete resection confirmed by histology and adverse events. Pooled risk ratios (RR) with 95 % confidence interval were calculated using a fixed effect model. Heterogeneity was assessed by I statistic. Funnel plots and Egger's test were used to assess publication bias. We used the Newcastle-Ottawa scale (NOS) for assessment of quality of observational studies, and the Cochrane tool for assessing risk of bias for RCTs Seven studies with 1291 patients were included; two were randomized controlled trials and five were observational. UEMR demonstrated statistically significantly better efficacy in rates of en bloc resection, pooled RR 1.16 (1.08, 1.26), complete macroscopic resection, pooled RR 1.28 (1.18, 1.39), recurrent/residual polyps; pooled RR 0.26 (0.12, 0.56) and complete resection confirmed by histology; pooled RR 0.75 (0.57, 0.98). There was no significant difference in adverse events (AEs); pooled RR 0.68 (0.44, 1.05). This meta-analysis found statistically significantly better rates of en bloc resection, complete macroscopic resection, and lower risk of recurrent/residual polyps with UEMR compared to EMR. We found no significant difference in AEs between the two techniques.
最近，水下内镜黏膜切除术（UEMR）在结直肠息肉的治疗中显示出了良好的效果。一些研究表明，与传统内镜黏膜切除术（EMR）相比，其治疗效果更佳。我们进行了这项系统评价和荟萃分析，以比较UEMR和EMR在结直肠息肉治疗中的效果。我们检索了多个数据库，时间跨度从数据库创建至2019年11月，以确定比较UEMR和EMR的研究。评估的结果包括整块切除率、完全宏观切除率、随访结肠镜检查时息肉复发/残留率、组织学证实的完全切除率以及不良事件。使用固定效应模型计算合并风险比（RR）及95%置信区间。通过I²统计量评估异质性。采用漏斗图和Egger检验评估发表偏倚。我们使用纽卡斯尔-渥太华量表（NOS）评估观察性研究的质量，使用Cochrane工具评估随机对照试验的偏倚风险。纳入了7项研究，共1291例患者；其中2项为随机对照试验，5项为观察性研究。UEMR在整块切除率（合并RR 1.16，95%CI 1.08-1.26）、完全宏观切除率（合并RR 1.28，95%CI 1.18-1.39）、息肉复发/残留率（合并RR 0.26，95%CI 0.12-0.56）以及组织学证实的完全切除率（合并RR 0.75，95%CI 0.57-0.98）方面显示出统计学上显著更好的疗效。不良事件方面无显著差异（合并RR 0.68，95%CI 0.44-1.05）。这项荟萃分析发现，与EMR相比，UEMR在整块切除率、完全宏观切除率方面具有统计学上显著更高的比率，且息肉复发/残留风险更低。我们发现两种技术在不良事件方面无显著差异。
