Yamashina Takeshi, Hanaoka Noboru, Setoyama Takeshi, Watanabe Jun, Banno Masahiro, Marusawa Hiroyuki
Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, JPN.
Gastroenterology and Hepatology, Kansai Medical University Medical Center, Moriguchi, JPN.
Cureus. 2021 Aug 17;13(8):e17261. doi: 10.7759/cureus.17261. eCollection 2021 Aug.
Recently, underwater endoscopic mucosal resection (UEMR) without submucosal injection was introduced as a new replacement for conventional EMR (CEMR) and was reported to be useful for resecting large colonic polyps. Here, we aimed to assess the efficacy and safety of these two methods by a systematic review and meta-analysis. We comprehensively searched multiple databases until July 2021 to identify randomized controlled trials (RCTs) comparing UEMR with CEMR. The primary outcomes were the proportion of R0 resection and mean procedure time, and the secondary outcomes were the proportion of en bloc resection and all adverse events. Three reviewers independently searched for articles, extracted data, and assessed the risk of bias. We evaluated the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach. This study was registered in www.protocols.io (Protocol Integer ID: 40849). We included six RCTs (1,374 polyps). We judged that a meta-analysis was not available, and the data were summarized narratively for the proportion of R0 resection. Regarding procedure time, UEMR likely resulted in a large reduction (mean difference = -64.3 seconds; 95% confidence interval (CI) = -122.5 to -6.0 seconds; I = 86%; moderate certainty of evidence). UEMR likely resulted in a large increase in en bloc resection (odds ratio = 1.85; 95% CI = 1.15 to 2.98; I = 60%; moderate certainty of evidence). Percentages of adverse events were 0-17% with CEMR and 0-16% with UEMR. In summary, UEMR might have higher efficacy than CEMR in the endoscopic resection of nonpedunculated colorectal polyps, with likely a large reduction in procedure time.
最近，无需黏膜下注射的水下内镜黏膜切除术（UEMR）作为传统内镜黏膜切除术（CEMR）的一种新替代方法被引入，并据报道对切除大肠大息肉有用。在此，我们旨在通过系统评价和荟萃分析评估这两种方法的疗效和安全性。我们全面检索了多个数据库直至2021年7月，以识别比较UEMR与CEMR的随机对照试验（RCT）。主要结局是R0切除比例和平均手术时间，次要结局是整块切除比例和所有不良事件。三位评价者独立检索文章、提取数据并评估偏倚风险。我们使用推荐分级、评估、制定和评价方法评估证据的确定性。本研究已在www.protocols.io注册（方案整数ID：40849）。我们纳入了6项RCT（1374枚息肉）。我们判断无法进行荟萃分析，因此对R0切除比例的数据进行了描述性总结。关于手术时间，UEMR可能导致大幅缩短（平均差值=-64.3秒；95%置信区间（CI）=-122.5至-6.0秒；I²=86%；证据确定性中等）。UEMR可能导致整块切除率大幅提高（比值比=1.85；95%CI=1.15至2.98；I²=60%；证据确定性中等）。CEMR的不良事件发生率为0-17%，UEMR为0-16%。总之，在非带蒂结直肠息肉的内镜切除中，UEMR可能比CEMR具有更高的疗效，且手术时间可能大幅缩短。
