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  • Title: Underwater endoscopic mucosal resection for recurrences after previous piecemeal resection of colorectal polyps (with video).
    Author: Kim HG, Thosani N, Banerjee S, Chen A, Friedland S.
    Journal: Gastrointest Endosc; 2014 Dec; 80(6):1094-102. PubMed ID: 25012560.
    Abstract:
    BACKGROUND: Conventional endoscopic treatment of a recurrent adenoma after piecemeal EMR (PEMR) of a colorectal laterally spreading tumor (LST) is technically difficult with low en bloc resection rates because of the inability to snare fibrotic residual. OBJECTIVE: To assess the feasibility of salvage underwater EMR (UEMR) for the treatment of recurrent adenoma after PEMR of a colorectal LST. DESIGN: Retrospective, cross-sectional study. SETTING: Single, tertiary-care referral center. PATIENTS: Patients who have recurrent adenoma after PEMR of colorectal LST (≥2 cm). INTERVENTIONS: UEMR versus EMR. MAIN OUTCOME MEASUREMENT: En bloc resection rate, endoscopic complete removal rate, recurrence rate on follow-up colonoscopy, adjunctive ablation rate with argon plasma coagulation (APC) during salvage procedure, and independent predictive factors for successful en bloc resection and endoscopic complete removal. RESULTS: Eighty salvage procedures (36 UEMRs vs 44 EMRs) were analyzed. En bloc resection rate (47.2% vs 15.9%, P = .002) and endoscopic complete removal rate (88.9% vs 31.8%, P < .001) were higher in the UEMR group than in the EMR group. APC ablation of visible residual during salvage procedure was lower in UEMR group than EMR group (11.1% vs 65.9%, P < .001). Recurrence rate on follow-up colonoscopy was significantly lower in the UEMR group than the EMR group (10% vs 39.4%, P = .02). UEMR was an independent predictor of successful en bloc resection and endoscopic complete removal. LIMITATIONS: Retrospective, single-center study. CONCLUSIONS: UEMR can be a useful and feasible technique as a salvage procedure for recurrent colorectal adenoma after PEMR.
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