Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2022 Apr;37(4):741-748.
doi: 10.1111/jgh.15769. Epub 2022 Jan 19.

Depth of the cutting plane with underwater and conventional endoscopic mucosal resection: Post-hoc analysis of a randomized study

Katsunori Matsueda  1 , Yoji Takeuchi  1 , Masanori Kitamura  2 , Takeshi Yamashina  3 , Tomofumi Akasaka  4   5 , Taro Iwatsubo  6 , Yasuki Nakatani  7 , Takuji Akamatsu  7 , Takuji Kawamura  8 , Shigehiko Fujii  9 , Toshihiro Kusaka  9 , Toshio Shimokawa  10 , Noriya Uedo  1
Affiliations
Randomized Controlled Trial

Depth of the cutting plane with underwater and conventional endoscopic mucosal resection: Post-hoc analysis of a randomized study

Katsunori Matsueda et al. J Gastroenterol Hepatol. 2022 Apr.

Abstract

Background and aim: A multicenter randomized controlled trial reported a better R0 resection rate for intermediate-sized (10-20 mm) colorectal polyps with underwater endoscopic mucosal resection (UEMR) than conventional endoscopic mucosal resection (CEMR). To clarify whether UEMR removes enough submucosal tissue in the removal of unpredictable invasive cancers, we investigated the cutting plane depth with UEMR versus CEMR.

Methods: This was a post-hoc analysis of a randomized controlled trial in which 210 intermediate-sized colorectal polyps were removed in five Japanese hospitals. One pathologist and two gastroenterologists independently reviewed all resected specimens and measured the cutting plane depth. The cutting plane depth was evaluated as (i) maximum depth of submucosal layer and (ii) mean depth of submucosal layer, calculated using a virtual pathology system.

Results: We identified 168 appropriate specimens for the evaluation of the cutting plane depth, resected by UEMR (n = 88) and CEMR (n = 80). The median resection depth was not significantly different between UEMR and CEMR specimens, regardless of the measurement method ([i] 1317 vs 1290 μm, P = 0.52; [ii] 619 vs 545 μm, P = 0.32). All specimens in the UEMR and CEMR groups contained substantial submucosa and no muscularis propria.

Conclusions: The cutting plane depth with UEMR was comparable with that with CEMR. UEMR can be a viable alternative method that adequately resects the submucosal layer for the histopathological assessment of unpredictable submucosal invasive cancers.

Keywords: Colorectal polyp; Cutting plane depth; Resection layer; Underwater endoscopic mucosal resection.

PubMed Disclaimer

References

    1. Binmoeller KF, Weilert F, Shah J, Bhat Y, Kane S. “Underwater” EMR without submucosal injection for large sessile colorectal polyps (with video). Gastrointest. Endosc. 2012; 75: 1086-1091.
    1. Inoue T, Nakagawa K, Yamasaki Y et al. Underwater endoscopic mucosal resection versus endoscopic submucosal dissection for 20-30 mm colorectal polyps. J. Gastroenterol. Hepatol. 2021.
    1. Fukuda H, Takeuchi Y, Shoji A et al. Curative value of underwater endoscopic mucosal resection for submucosally invasive colorectal cancer. J. Gastroenterol. Hepatol. 2021.
    1. Ohmori M, Yamasaki Y, Iwagami H et al. A propensity score-matched analysis of endoscopic resection for recurrent colorectal neoplasms: a pilot study. J. Gastroenterol. Hepatol. 2021.
    1. Curcio G, Granata A, Ligresti D et al. Underwater colorectal EMR: remodeling endoscopic mucosal resection. Gastrointest. Endosc. 2015; 81: 1238-1242.

Publication types

MeSH terms

LinkOut - more resources