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Underwater vs conventional endoscopic mucosal resection in the management of colorectal polyps: a systematic review and meta-analysis
Background Recently, underwater endoscopic mucosal resection (UEMR) has shown promising results in the management of colorectal polyps. Some studies have shown better outcomes compared to conventional endoscopic mucosal resection (EMR). We conducted this systematic review and meta-analysis to compa...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Georg Thieme Verlag KG
2020
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7508646/ https://www.ncbi.nlm.nih.gov/pubmed/33015327 http://dx.doi.org/10.1055/a-1214-5692 |
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author | Kamal, Faisal Khan, Muhammad Ali Lee-Smith, Wade Khan, Zubair Sharma, Sachit Tombazzi, Claudio Ahmad, Dina Ismail, Mohammad Kashif Howden, Colin W. Binmoeller, Kenneth F. |
author_facet | Kamal, Faisal Khan, Muhammad Ali Lee-Smith, Wade Khan, Zubair Sharma, Sachit Tombazzi, Claudio Ahmad, Dina Ismail, Mohammad Kashif Howden, Colin W. Binmoeller, Kenneth F. |
author_sort | Kamal, Faisal |
collection | PubMed |
description | Background Recently, underwater endoscopic mucosal resection (UEMR) has shown promising results in the management of colorectal polyps. Some studies have shown better outcomes compared to conventional endoscopic mucosal resection (EMR). We conducted this systematic review and meta-analysis to compare UEMR and EMR in the management of colorectal polyps. Methods We searched several databases from inception to November 2019 to identify studies comparing UEMR and EMR. Outcomes assessed included rates of en bloc resection, complete macroscopic resection, recurrent/residual polyps on follow-up colonoscopy, complete resection confirmed by histology and adverse events. Pooled risk ratios (RR) with 95 % confidence interval were calculated using a fixed effect model. Heterogeneity was assessed by I (2) statistic. Funnel plots and Egger’s test were used to assess publication bias. We used the Newcastle-Ottawa scale (NOS) for assessment of quality of observational studies, and the Cochrane tool for assessing risk of bias for RCTs Results Seven studies with 1291 patients were included; two were randomized controlled trials and five were observational. UEMR demonstrated statistically significantly better efficacy in rates of en bloc resection, pooled RR 1.16 (1.08, 1.26), complete macroscopic resection, pooled RR 1.28 (1.18, 1.39), recurrent/residual polyps; pooled RR 0.26 (0.12, 0.56) and complete resection confirmed by histology; pooled RR 0.75 (0.57, 0.98). There was no significant difference in adverse events (AEs); pooled RR 0.68 (0.44, 1.05). Conclusions This meta-analysis found statistically significantly better rates of en bloc resection, complete macroscopic resection, and lower risk of recurrent/residual polyps with UEMR compared to EMR. We found no significant difference in AEs between the two techniques. |
format | Online Article Text |
id | pubmed-7508646 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Georg Thieme Verlag KG |
record_format | MEDLINE/PubMed |
spelling | pubmed-75086462020-10-01 Underwater vs conventional endoscopic mucosal resection in the management of colorectal polyps: a systematic review and meta-analysis Kamal, Faisal Khan, Muhammad Ali Lee-Smith, Wade Khan, Zubair Sharma, Sachit Tombazzi, Claudio Ahmad, Dina Ismail, Mohammad Kashif Howden, Colin W. Binmoeller, Kenneth F. Endosc Int Open Background Recently, underwater endoscopic mucosal resection (UEMR) has shown promising results in the management of colorectal polyps. Some studies have shown better outcomes compared to conventional endoscopic mucosal resection (EMR). We conducted this systematic review and meta-analysis to compare UEMR and EMR in the management of colorectal polyps. Methods We searched several databases from inception to November 2019 to identify studies comparing UEMR and EMR. Outcomes assessed included rates of en bloc resection, complete macroscopic resection, recurrent/residual polyps on follow-up colonoscopy, complete resection confirmed by histology and adverse events. Pooled risk ratios (RR) with 95 % confidence interval were calculated using a fixed effect model. Heterogeneity was assessed by I (2) statistic. Funnel plots and Egger’s test were used to assess publication bias. We used the Newcastle-Ottawa scale (NOS) for assessment of quality of observational studies, and the Cochrane tool for assessing risk of bias for RCTs Results Seven studies with 1291 patients were included; two were randomized controlled trials and five were observational. UEMR demonstrated statistically significantly better efficacy in rates of en bloc resection, pooled RR 1.16 (1.08, 1.26), complete macroscopic resection, pooled RR 1.28 (1.18, 1.39), recurrent/residual polyps; pooled RR 0.26 (0.12, 0.56) and complete resection confirmed by histology; pooled RR 0.75 (0.57, 0.98). There was no significant difference in adverse events (AEs); pooled RR 0.68 (0.44, 1.05). Conclusions This meta-analysis found statistically significantly better rates of en bloc resection, complete macroscopic resection, and lower risk of recurrent/residual polyps with UEMR compared to EMR. We found no significant difference in AEs between the two techniques. Georg Thieme Verlag KG 2020-10 2020-09-22 /pmc/articles/PMC7508646/ /pubmed/33015327 http://dx.doi.org/10.1055/a-1214-5692 Text en The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/) https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited. |
spellingShingle | Kamal, Faisal Khan, Muhammad Ali Lee-Smith, Wade Khan, Zubair Sharma, Sachit Tombazzi, Claudio Ahmad, Dina Ismail, Mohammad Kashif Howden, Colin W. Binmoeller, Kenneth F. Underwater vs conventional endoscopic mucosal resection in the management of colorectal polyps: a systematic review and meta-analysis |
title | Underwater vs conventional endoscopic mucosal resection in the management of colorectal polyps: a systematic review and meta-analysis |
title_full | Underwater vs conventional endoscopic mucosal resection in the management of colorectal polyps: a systematic review and meta-analysis |
title_fullStr | Underwater vs conventional endoscopic mucosal resection in the management of colorectal polyps: a systematic review and meta-analysis |
title_full_unstemmed | Underwater vs conventional endoscopic mucosal resection in the management of colorectal polyps: a systematic review and meta-analysis |
title_short | Underwater vs conventional endoscopic mucosal resection in the management of colorectal polyps: a systematic review and meta-analysis |
title_sort | underwater vs conventional endoscopic mucosal resection in the management of colorectal polyps: a systematic review and meta-analysis |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7508646/ https://www.ncbi.nlm.nih.gov/pubmed/33015327 http://dx.doi.org/10.1055/a-1214-5692 |
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