Meta-Analysis
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2020; 8(20): 4826-4837
Published online Oct 26, 2020. doi: 10.12998/wjcc.v8.i20.4826
Underwater vs conventional endoscopic mucosal resection in treatment of colorectal polyps: A meta-analysis
Dong-Qiong Ni, Yu-Ping Lu, Xi-Qiao Liu, Li-Ying Gao, Xuan Huang
Dong-Qiong Ni, Department of Gastroenterology, Affiliated Hospital of Shaoxing University, Shaoxing 312000, Zhejiang Province, China
Yu-Ping Lu, Xi-Qiao Liu, Li-Ying Gao, Xuan Huang, Department of Gastroenterology, The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
Author contributions: Ni DQ proposed the research concept, analyzed the data, and wrote the manuscript; Lu YP, Liu XQ, and Gao LY collected the data and assessed the quality score; Huang X critically revised the manuscript; all authors have read and approved the final manuscript.
Supported by Traditional Chinese Medicine Science and Technology Program of Zhejiang Province of China, No. 2016ZA089; and Zhejiang Medical and Health Science and Technology Project, No. 2020RC025.
Conflict-of-interest statement: Xuan Huang has received research funding from Traditional Chinese Medicine Science and Technology Program of Zhejiang Province of China (2016ZA089) and Zhejiang Medical and Health Science and Technology Project (2020RC025).
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xuan Huang, PhD, Doctor, Professor, Department of Gastroenterology, The First Affiliated Hospital, Zhejiang Chinese Medical University, No. 54 Youdian Road, Hangzhou 310006, Zhejiang Province, China. huangxuan1976@163.com
Received: May 16, 2020
Peer-review started: May 16, 2020
First decision: July 29, 2020
Revised: August 9, 2020
Accepted: September 3, 2020
Article in press: September 3, 2020
Published online: October 26, 2020
Processing time: 162 Days and 20.3 Hours
Abstract
BACKGROUND

Underwater endoscopic mucosal resection (UEMR) of colorectal lesions is emerging as an alternative method to conventional endoscopic mucosal resection (EMR); however, it is still controversial whether there is a difference in the effectiveness between UEMR and EMR.

AIM

To evaluate the effectiveness and safety of UEMR in the treatment of colorectal polyps.

METHODS

Clinical studies comparing the effectiveness or safety of UEMR in the treatment of colorectal polyps were searched in medical databases, including PubMed, Embase, Cochrane Library, CNKI, and Wanfang Data, monographs, theses, and papers presented at conferences. Statistical analyses were performed using Revman 5.3 software.

RESULTS

Seven non-randomized controlled trials and one randomized controlled trial met the inclusion criteria. In total, 1382 patients (1511 polyps) were included in the study, including 722 who received UEMR and 789 who received EMR. In the UEMR and EMR groups, the en bloc resection rates were 85.87% and 73.89%, respectively, with a relative risk (RR) value of 1.14 (95% confidence interval [CI]: 1.01-1.30; P < 0.05). In the sub-group analysis, the en bloc resection rate showed no statistically significant difference between the EMR and UEMR groups for polyps less than 20 mm in diameter. However, a statistically significant difference was found between the EMR and UEMR groups for polyps equal to or greater than 20 mm in diameter. The post-endoscopic resection recurrence rates at 3-6 mo of the UEMR and EMR groups were 3.26% and 15.17%, respectively, with an RR value of 0.27 (95%CI: 0.09-0.83; P < 0.05). The post-endoscopic resection recurrence rates of UEMR and EMR at 12 mo were 6.25% and 14.40%, respectively, with an RR value of 0.43 (95%CI: 0.20-0.92; P < 0.05). Additionally, the incidence of adverse events was 8.17% and 6.21%, respectively, with an RR value of 1.07 (95%CI: 0.50-2.30; P > 0.05).

CONCLUSION

UEMR is an effective technique for colorectal polyps and appears to have some advantages over EMR, particularly with regard to some treatment outcomes.

Keywords: Underwater endoscopic mucosal resection; Conventional endoscopic mucosal resection; Colorectal polyps; Meta-analysis; Endoscopic mucosal resection

Core Tip: In this work, we aimed to evaluate the effectiveness and safety of underwater endoscopic mucosal resection in the treatment of colorectal polyps. This is the first meta-analysis comparing the effectiveness and safety of underwater vs conventional endoscopic mucosal resection for colorectal polyps.