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. 2024 Mar 3;14(5):536.
doi: 10.3390/diagnostics14050536.

Feasibility and Efficacy of Gastric Underwater Endoscopic Mucosal Resection

Dong Hyun Kim  1 , Seon Young Park  1 , Jin Won Kim  1 , Hyun Soo Kim  1
Affiliations

Feasibility and Efficacy of Gastric Underwater Endoscopic Mucosal Resection

Dong Hyun Kim et al. Diagnostics (Basel). .

Abstract

Gastric cancer, a leading cause of cancer-related deaths globally, necessitates effective and early detection and treatment strategies. Endoscopic resection techniques, particularly endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), have evolved significantly, enhancing the treatment of gastric neoplasms. Underwater endoscopic mucosal resection (UEMR) is a widely used technique for the resection of duodenal and colorectal neoplasms. However, the feasibility and efficacy of UEMR in the stomach are not well established. This retrospective observational study, conducted at a tertiary medical center, evaluated the efficacy and safety of UEMR in 81 patients with gastric neoplasms. Thus, it indicates that UEMR is a highly effective and safe technique for managing small to medium-sized gastric neoplasms, achieving 100% en bloc and 93.8% R0 resection rates with a low incidence of complications. Moreover, the procedure time was found to be significantly shorter for UEMR compared to ESD, thus highlighting its efficiency. While UEMR demonstrates high safety and efficacy, it is not suitable for all patients, with some requiring conversion to ESD as a treatment option. Despite the promising results, broader validation through extensive and randomized trials is recommended to establish UEMR as a standard approach in gastric cancer management.

Keywords: endoscopic mucosal resection; endoscopy; stomach neoplasms; water.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Gastric UEMR procedure example (A) narrow-band imaging reveals an 8-mm flat lesion with a central depression located at the great curvature of the antrum. (B) The lesion being snared in an underwater state during the UEMR procedure. (C) Post-UEMR view shows the site after successful removal of the neoplasm. Abbreviation: UEMR, underwater endoscopic mucosal resection.
Figure 2
Figure 2
Failed UEMR case leading to conversion to ESD. (A,B) An approximately 18-mm flat neoplasm situated at the lesser curvature of the antrum, illustrating the technical challenge of UEMR. (C) The neoplasm undergoing ESD following an unsuccessful UEMR attempt. (D) The resected specimen post-ESD procedure. Abbreviation: ESD, endoscopic submucosal dissection; UEMR, underwater endoscopic mucosal resection.
See this image and copyright information in PMC

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