Underwater versus conventional EMR for nonpedunculated colorectal lesions: a randomized clinical trial

Post written by Luciano Lenz, PhD, from the Instituto do Cancer do Estado de São Paulo, and Fleury Medicina e Saude, São Paulo, São Paulo, Brazil.


The focus of our study was to compare recurrence after underwater endoscopic mucosal resection (UEMR) and after conventional endoscopic mucosal resection (CEMR) for naïve nonpedunculated lesions.

This study is important because conventional mucosectomy, although the standard technique, still has a relatively high recurrence rate. Therefore, the search for alternatives is justified.

Our study demonstrated that UEMR was associated with a lower adenoma recurrence rate than CEMR. The relative risk of a 6-month recurrence rate in the CEMR group was 7.5-fold higher (95% confidence interval, 0.98-58.20).

We intend to follow these patients for a longer time, with multiple surveillance colonoscopies, so that we can perform a survival analysis with hazard ratio generation to make our data even more robust.

In conclusion, this randomized controlled study shows that both UEMR and CEMR are effective and have similar rates of adverse events. These results are in agreement with those of previous studies. In our study, UEMR was associated with a lower recurrence rate.

However, more trials with more patients and long-term follow-up care are desired to confirm this observation and to consider UEMR as the first-line choice for resecting nonpedunculated colorectal lesions.

Lenz_figureGraphical Abstract

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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