Singh Sahib, Mohan Babu P, Vinayek Rakesh, Dutta Sudhir, Dahiya Dushyant Singh, Inamdar Sumant, Suresh Kumar Vishnu Charan, Aswath Ganesh, Sharma Neil, Adler Douglas G
Department of Internal Medicine, Sinai Hospital of Baltimore, Baltimore, Maryland, USA.
Department of Gastroenterology & Hepatology, Orlando Gastroenterology PA, Orlando, Florida, USA.
Gastrointest Endosc. 2025 Mar;101(3):551-557.e5. doi: 10.1016/j.gie.2024.10.029. Epub 2024 Oct 19.
Effect of underwater endoscopic submucosal dissection (UESD) on clinical outcomes as compared with conventional ESD (CESD) remains unclear. We conducted a meta-analysis of the available data.
Online databases were searched for studies comparing UESD with CESD for colorectal lesions. The outcomes of interest were en-bloc resection, R0 resection, procedure time (minutes), dissection speed (mm/min), and adverse events. Pooled odds ratios (ORs) and standardized mean difference (SMD), along with 95% confidence intervals (CIs) were calculated.
Seven studies with 1401 patients (UESD, 452; CESD, 949) were included. Mean patient age was 69 years, and 57% of patients were men. UESD had both a shorter procedure time (SMD, -1.33; 95% CI, -2.34 to -.32; P = .010) and greater dissection speed (SMD, 1.01; 95% CI, .35-1.68; P = .003) when compared with CESD. No significant differences were observed between the 2 groups with respect to en-bloc resection (OR, 1.13; 95% CI, .37-3.41), R0 resection (OR, 2.36; 95% CI, .79-7.05), delayed bleeding (OR, 1.34; 95% CI, .65-2.74), perforation (OR, 1.13; 95% CI, .64-2.00), and postresection electrocoagulation syndrome (OR, .38; 95% CI, .10-1.42).
UESD was faster in patients with colorectal lesions but had comparable rates of en-bloc resection, R0 resection, and adverse events when compared with CESD.
与传统内镜黏膜下剥离术（CESD）相比，水下内镜黏膜下剥离术（UESD）对临床结局的影响尚不清楚。我们对现有数据进行了荟萃分析。
检索在线数据库，查找比较UESD与CESD治疗结直肠病变的研究。感兴趣的结局包括整块切除、R0切除、手术时间（分钟）、剥离速度（毫米/分钟）和不良事件。计算合并比值比（OR）和标准化均数差（SMD）以及95%置信区间（CI）。
纳入7项研究，共1401例患者（UESD组452例，CESD组949例）。患者平均年龄为69岁，57%为男性。与CESD相比，UESD的手术时间更短（SMD，-1.33；95%CI，-2.34至-0.32；P = 0.010），剥离速度更快（SMD，1.01；95%CI，0.35 - 1.68；P = 0.003）。两组在整块切除（OR，1.13；95%CI，0.37 - 3.41）、R0切除（OR，2.36；95%CI，0.79 - 7.05）、延迟出血（OR，1.34；95%CI，0.65 - 2.74）、穿孔（OR，1.13；95%CI，0.64 - 2.00）和切除后电凝综合征（OR，0.38；95%CI，0.10 - 1.42）方面未观察到显著差异。
对于结直肠病变患者，UESD速度更快，但与CESD相比，整块切除率、R0切除率和不良事件发生率相当。
