High complete resection rates of underwater endoscopic mucosal resection for intermediate-sized sessile serrated lesions.

Authors

Junki Toyosawa, Masayasu Ohmori, Yasushi Yamasaki, Yuki Aoyama, Shoko Igawa, Keiko Takeuchi, Toshihiro Inokuchi, Hideaki Kinugasa, Masahiro Takahara, Sakiko Hiraoka, Takehiro Tanaka, Motoyuki Otsuka

Published in

Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society. Apr 15, 2025. Epub Apr 15, 2025.

Abstract

Sessile serrated lesions (SSLs) pose a risk of carcinoma, necessitating endoscopic resection. Conventional endoscopic mucosal resection (EMR) often fails to achieve complete resection for intermediate-sized SSLs. Although underwater EMR (UEMR) is being increasingly used for colon polyps, its efficacy for SSLs remains unclear. This study evaluated the complete resection rate of UEMR for intermediate-sized SSLs.
This prospective, single-arm, observational study was conducted at two institutions. Patients with endoscopically diagnosed intermediate-sized SSLs (10-20 mm) were enrolled. UEMR was performed, and specimens were histologically assessed. Post-UEMR lesions were closely examined, and biopsies were taken to check for residuals. Follow-up colonoscopy was performed 1 year later to evaluate recurrence. The primary end-point was the complete resection rate, defined as no residual in biopsy specimens. The secondary end-points were the rates of R0 resection, en bloc resection, recurrence, adverse events, and factors regarding procedural difficulty.
In total, 103 patients with 133 lesions were consecutively identified. Twenty-seven cases with 30 lesions were excluded by criteria; 103 endoscopically diagnosed SSLs were enrolled. The median postresection lesion size was 12 mm (range 8-23). The R0 and en bloc resection rates were 61% and 91%, respectively. The overall complete resection rate was 97% (95% confidence interval 91.8-99.0%). Follow-up colonoscopy in 87 lesions showed no recurrence. Only one patient (1%) experienced delayed bleeding. Snaring difficulty was significantly associated with piecemeal resection.
The complete resection rate of UEMR for intermediate-sized SSLs was acceptable. UEMR may become a standard treatment for intermediate-sized SSLs.

PMID:
40231334
Bibliographic data and abstract were imported from PubMed on 15 Apr 2025.

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