Sferrazza Sandro, Calabrese Giulio, Maselli Roberta, Morais Rui, Facciorusso Antonio, Mavrogenis Georgios, Di Mitri Roberto, Repici Alessandro, Maida Marcello
Gastroenterology and Endoscopy Unit, ARNAS Civico Di Cristina Benfratelli Hospital, 90127 Palermo, Italy.
Digestive Endoscopy Unit, Humanitas Clinical and Research Hospital, Rozzano, 20089 Milan, Italy.
Cancers (Basel). 2024 Oct 19;16(20):3535. doi: 10.3390/cancers16203535.
The endoscopic resection of gastrointestinal tract lesions embraces different types of techniques, ranging from conventional polypectomy/endoscopic mucosal resection (EMR) to the field of third-space endoscopy, including endoscopic submucosal dissection (ESD), full-thickness resection and peroral endoscopic myotomy (POEM). Parallelly, the advent of underwater techniques has served as an add-on for both basic and advanced procedures, since its first report in 2012. We aimed to provide a comprehensive update on the state of the art about the feasibility of underwater basic and advanced techniques for GI endoscopy. Underwater EMR (U-EMR) has proved effective and safe in treating > 10 mm sessile or flat or all-size recurrent colonic lesions. Conversely, although data show good effectiveness and safety for <10 mm lesions, it is preferred when high-grade dysplasia is suspected, favouring cold snare polypectomy for all other cases. Moreover, promising data are emerging regarding the feasibility of U-ESD for difficult-to-resect colonic lesions. U-EMR represents a standard of care for treating < 25 mm superficial non-ampullary duodenal epithelial tumours. Data regarding oesophageal, gastric and ampullary lesions remains limited to small cohorts. Finally, using water immersion for POEM has shown a reduction in procedure time compared to the CO insufflation technique for vessel coagulation, albeit in a single-centre experience. Based on these results, U-EMR has become a standard for treating intermediate-size colonic and non-ampullary duodenal lesions, as highlighted also in the European Society of Gastrointestinal Endoscopy guidelines. Promising results have been shown in third-space endoscopy studies, even though further prospective studies are awaited to standardise the technique for both ESD and POEM.
胃肠道病变的内镜切除涵盖了不同类型的技术，从传统的息肉切除术/内镜黏膜切除术（EMR）到第三空间内镜领域，包括内镜黏膜下剥离术（ESD）、全层切除术和经口内镜肌切开术（POEM）。与此同时，自2012年首次报道以来，水下技术的出现为基础和高级手术提供了补充。我们旨在全面更新关于水下基础和高级技术在胃肠内镜检查中可行性的最新技术水平。水下EMR（U-EMR）已被证明在治疗直径大于10mm的无蒂或扁平或各种大小的复发性结肠病变方面有效且安全。相反，尽管数据显示对于直径小于10mm的病变具有良好的有效性和安全性，但当怀疑有高级别异型增生时更倾向于采用该方法，其他所有情况则更倾向于冷圈套息肉切除术。此外，关于U-ESD治疗难以切除的结肠病变的可行性，也出现了一些有前景的数据。U-EMR是治疗直径小于25mm的浅表非壶腹十二指肠上皮肿瘤的标准治疗方法。关于食管、胃和壶腹病变的数据仍然仅限于小样本队列。最后，与用于血管凝血的二氧化碳充气技术相比，在POEM中使用水浸已显示手术时间缩短，尽管这只是单中心经验。基于这些结果，U-EMR已成为治疗中等大小结肠和非壶腹十二指肠病变的标准方法，欧洲胃肠内镜学会指南中也强调了这一点。在第三空间内镜研究中已显示出有前景的结果，尽管还需要进一步的前瞻性研究来规范ESD和POEM的技术。
