Underwater Endoscopic Mucosal Resection of Serrated Adenomas

Overview

Journal Clinics (Sao Paulo)

Publisher Elsevier

Specialty General Medicine

Date 2018 Oct 11

PMID 30304298

Citations 10

Authors

Dalton Marques Chaves

Helcio Pedrosa Brito

Lumi Tomishige Chaves

Rodrigo Azevedo Rodrigues

Beatriz Monica Sugai

Affiliations

Soon will be listed here.

Abstract

Objectives: Serrated polyps, which are considered to be precursors of colorectal carcinoma, include hyperplastic polyps, sessile serrated adenomas and traditional serrated adenomas. With the exception of hyperplastic polyps, all of these lesions must be removed. This study sought to examine whether underwater endoscopic mucosal resection is a safe and effective technique for treating serrated polyps.

Methods: Cases in which patients were submitted for underwater endoscopic mucosal resection and histologically diagnosed with sessile serrated adenoma were prospectively registered.

Results: The median patient age was 54.5 years (range, 48 to 72 years), and the patients included 4 men (28.5%) and 10 women (71.5%). One lesion (6.2%), 10 lesions (62.5%), 1 lesion (6.2%), 3 lesions (18.8%) and 1 lesion (6.2%) were found in the cecum, the ascending colon, the hepatic flexure, the transverse colon and the descending colon, respectively. The median lesion size was 20 mm (range, 10 to 35 mm). Eight lesions (50%) were removed en bloc, and the remaining eight lesions (50%) were removed using a piecemeal technique. None of the cases were complicated by perforation or delayed bleeding.

Conclusion: Underwater resection could be a feasible, safe and effective alternative for the resection of sessile serrated adenomas.

Citing Articles

Underwater Techniques in Gastrointestinal Endoscopy: Diving into the Depths.

Sferrazza S, Calabrese G, Maselli R, Morais R, Facciorusso A, Mavrogenis G Cancers (Basel). 2024; 16(20).

PMID: 39456629 PMC: 11506518. DOI: 10.3390/cancers16203535.

Outcomes of underwater endoscopic mucosal resection for colorectal polyps-Insights from western India.

Sundaram S, Patil G, Jain A, Dalal A, Patil P, Mehta S Indian J Gastroenterol. 2024; 44(1):80-87.

PMID: 39243341 DOI: 10.1007/s12664-024-01661-8.

Endoscopic techniques for management of large colorectal polyps, strictures and leaks.

Gordon S, Eichenwald L, Systrom H Surg Open Sci. 2024; 20:156-168.

PMID: 39100384 PMC: 11296069. DOI: 10.1016/j.sopen.2024.06.012.

Cold EMR vs. Hot EMR for the removal of sessile serrated polyps larger than 10 mm: a systematic review and meta-analysis.

Ding C, Yang J, Wang X, Zhou Y, Khizar H, Jin Z BMC Surg. 2024; 24(1):93.

PMID: 38509508 PMC: 10953062. DOI: 10.1186/s12893-024-02325-2.

Underwater versus conventional endoscopic mucosal resection for colorectal lesions: a systematic review and meta-analysis of randomized clinical trials.

de Souza M, Arruda do Espirito Santo P, Maluf-Filho F, Lenz L Int J Colorectal Dis. 2023; 38(1):208.

PMID: 37552342 DOI: 10.1007/s00384-023-04505-7.

References

Binmoeller K, Weilert F, Shah J, Bhat Y, Kane S . "Underwater" EMR without submucosal injection for large sessile colorectal polyps (with video). Gastrointest Endosc. 2012; 75(5):1086-91. DOI: 10.1016/j.gie.2011.12.022. View

Rex D, Ahnen D, Baron J, Batts K, Burke C, Burt R . Serrated lesions of the colorectum: review and recommendations from an expert panel. Am J Gastroenterol. 2012; 107(9):1315-29. PMC: 3629844. DOI: 10.1038/ajg.2012.161. View

Pohl J, Schneider A, Vogell H, Mayer G, Kaiser G, Ell C . Pancolonic chromoendoscopy with indigo carmine versus standard colonoscopy for detection of neoplastic lesions: a randomised two-centre trial. Gut. 2010; 60(4):485-90. DOI: 10.1136/gut.2010.229534. View

Binmoeller K, Hamerski C, Shah J, Bhat Y, Kane S . Underwater EMR of adenomas of the appendiceal orifice (with video). Gastrointest Endosc. 2015; 83(3):638-42. DOI: 10.1016/j.gie.2015.08.079. View

Abdeljawad K, Vemulapalli K, Kahi C, Cummings O, Snover D, Rex D . Sessile serrated polyp prevalence determined by a colonoscopist with a high lesion detection rate and an experienced pathologist. Gastrointest Endosc. 2014; 81(3):517-24. DOI: 10.1016/j.gie.2014.04.064. View

Uedo N, Nemeth A, Johansson G, Toth E, Thorlacius H . Underwater endoscopic mucosal resection of large colorectal lesions. Endoscopy. 2014; 47(2):172-4. DOI: 10.1055/s-0034-1390749. View

Singh R, Zorron Cheng Tao Pu L, Koay D, Burt A . Sessile serrated adenoma/polyps: Where are we at in 2016?. World J Gastroenterol. 2016; 22(34):7754-9. PMC: 5016375. DOI: 10.3748/wjg.v22.i34.7754. View

Hewett D, Rex D . Colonoscopy and diminutive polyps: hot or cold biopsy or snare? Do I send to pathology?. Clin Gastroenterol Hepatol. 2010; 9(2):102-5. DOI: 10.1016/j.cgh.2010.09.024. View

Lieberman D, Rex D, Winawer S, Giardiello F, Johnson D, Levin T . Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2012; 143(3):844-857. DOI: 10.1053/j.gastro.2012.06.001. View

10.

Sano W, Sano Y, Iwatate M, Hasuike N, Hattori S, Kosaka H . Prospective evaluation of the proportion of sessile serrated adenoma/polyps in endoscopically diagnosed colorectal polyps with hyperplastic features. Endosc Int Open. 2015; 3(4):E354-8. PMC: 4554512. DOI: 10.1055/s-0034-1391948. View

11.

Kimura T, Yamamoto E, Yamano H, Suzuki H, Kamimae S, Nojima M . A novel pit pattern identifies the precursor of colorectal cancer derived from sessile serrated adenoma. Am J Gastroenterol. 2012; 107(3):460-9. DOI: 10.1038/ajg.2011.457. View

12.

Rosty C, Hewett D, Brown I, Leggett B, Whitehall V . Serrated polyps of the large intestine: current understanding of diagnosis, pathogenesis, and clinical management. J Gastroenterol. 2012; 48(3):287-302. PMC: 3698429. DOI: 10.1007/s00535-012-0720-y. View

13.

Ponugoti P, Rex D . Perforation during underwater EMR. Gastrointest Endosc. 2016; 84(3):543-4. DOI: 10.1016/j.gie.2016.01.021. View

14.

Tadepalli U, Feihel D, Miller K, Itzkowitz S, Freedman J, Kornacki S . A morphologic analysis of sessile serrated polyps observed during routine colonoscopy (with video). Gastrointest Endosc. 2011; 74(6):1360-8. DOI: 10.1016/j.gie.2011.08.008. View

15.

Moussata D, Boschetti G, Chauvenet M, Stroeymeyt K, Nancey S, Berger F . Endoscopic and histologic characteristics of serrated lesions. World J Gastroenterol. 2015; 21(10):2896-904. PMC: 4356908. DOI: 10.3748/wjg.v21.i10.2896. View

16.

Hazewinkel Y, Lopez-Ceron M, East J, Rastogi A, Pellise M, Nakajima T . Endoscopic features of sessile serrated adenomas: validation by international experts using high-resolution white-light endoscopy and narrow-band imaging. Gastrointest Endosc. 2013; 77(6):916-24. DOI: 10.1016/j.gie.2012.12.018. View

17.

Goldstein N, Bhanot P, Odish E, Hunter S . Hyperplastic-like colon polyps that preceded microsatellite-unstable adenocarcinomas. Am J Clin Pathol. 2003; 119(6):778-96. DOI: 10.1309/DRFQ-0WFU-F1G1-3CTK. View

18.

Wang A, Flynn M, Patrie J, Cox D, Bleibel W, Mann J . Underwater endoscopic mucosal resection of colorectal neoplasia is easily learned, efficacious, and safe. Surg Endosc. 2013; 28(4):1348-54. DOI: 10.1007/s00464-013-3297-5. View