{"title":"水下与常规内镜粘膜切除术治疗无带蒂结直肠肿瘤:一项随机对照试验。","authors":"Quang D Le, Nhan Q Le, Duc T Quach","doi":"10.4240/wjgs.v17.i6.103635","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Underwater endoscopic mucosal resection (UEMR) has been shown to be a good treatment option for the management of nonpedunculated polyps ≥ 10 mm since its introduction. However, there is a paucity of randomized controlled trials (RCTs) in Asia.</p><p><strong>Aim: </strong>To compare the efficacy and safety of UEMR with those of conventional EMR (CEMR) in treating nonpedunculated colorectal lesions.</p><p><strong>Methods: </strong>We carried out this RCT at a tertiary hospital from October 2022 to July 2024. Patients with nonpedunculated colorectal neoplasms ranging from 10 mm to 30 mm in size were randomly assigned to either the UEMR or CEMR group. The primary outcome was the curative resection (R0) rate. The secondary outcomes included <i>en bloc</i> resection, procedure time, adverse events, and the number of clips used for defect closure.</p><p><strong>Results: </strong>A total of 260 patients with 260 lesions (130 in each UEMR and CEMR group) were recruited. The median age was 58 (27-85) years, the male/female ratio was 1.74, and the median lesion size was 20 (10-30 mm) mm. Compared with CEMR, UEMR was associated with a significantly greater curative resection (R0) rate (98.4% <i>vs</i> 90.3%; <i>P</i> = 0.007), greater <i>en bloc</i> resection rate (100% <i>vs</i> 94.6%; <i>P</i> = 0.014), shorter procedure time (65 <i>vs</i> 185 seconds; <i>P</i> < 0.001), lower rate of bleeding complications (1.5% <i>vs</i> 10%; <i>P</i> = 0.003), and fewer clips used (2 <i>vs</i> 3; <i>P</i> < 0.001). No perforations were observed in either group.</p><p><strong>Conclusion: </strong>Compared with CEMR<b>,</b> UEMR has a higher R0 rate, greater <i>en bloc</i> resection rate, shorter procedure time, fewer bleeding complications, and clips used in the management of nonpedunculated colorectal neoplasms.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 6","pages":"103635"},"PeriodicalIF":1.7000,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188596/pdf/","citationCount":"0","resultStr":"{\"title\":\"Underwater <i>vs</i> conventional endoscopic mucosal resection for nonpedunculated colorectal neoplasms: A randomized controlled trial.\",\"authors\":\"Quang D Le, Nhan Q Le, Duc T Quach\",\"doi\":\"10.4240/wjgs.v17.i6.103635\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Underwater endoscopic mucosal resection (UEMR) has been shown to be a good treatment option for the management of nonpedunculated polyps ≥ 10 mm since its introduction. However, there is a paucity of randomized controlled trials (RCTs) in Asia.</p><p><strong>Aim: </strong>To compare the efficacy and safety of UEMR with those of conventional EMR (CEMR) in treating nonpedunculated colorectal lesions.</p><p><strong>Methods: </strong>We carried out this RCT at a tertiary hospital from October 2022 to July 2024. Patients with nonpedunculated colorectal neoplasms ranging from 10 mm to 30 mm in size were randomly assigned to either the UEMR or CEMR group. The primary outcome was the curative resection (R0) rate. The secondary outcomes included <i>en bloc</i> resection, procedure time, adverse events, and the number of clips used for defect closure.</p><p><strong>Results: </strong>A total of 260 patients with 260 lesions (130 in each UEMR and CEMR group) were recruited. The median age was 58 (27-85) years, the male/female ratio was 1.74, and the median lesion size was 20 (10-30 mm) mm. Compared with CEMR, UEMR was associated with a significantly greater curative resection (R0) rate (98.4% <i>vs</i> 90.3%; <i>P</i> = 0.007), greater <i>en bloc</i> resection rate (100% <i>vs</i> 94.6%; <i>P</i> = 0.014), shorter procedure time (65 <i>vs</i> 185 seconds; <i>P</i> < 0.001), lower rate of bleeding complications (1.5% <i>vs</i> 10%; <i>P</i> = 0.003), and fewer clips used (2 <i>vs</i> 3; <i>P</i> < 0.001). No perforations were observed in either group.</p><p><strong>Conclusion: </strong>Compared with CEMR<b>,</b> UEMR has a higher R0 rate, greater <i>en bloc</i> resection rate, shorter procedure time, fewer bleeding complications, and clips used in the management of nonpedunculated colorectal neoplasms.</p>\",\"PeriodicalId\":23759,\"journal\":{\"name\":\"World Journal of Gastrointestinal Surgery\",\"volume\":\"17 6\",\"pages\":\"103635\"},\"PeriodicalIF\":1.7000,\"publicationDate\":\"2025-06-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188596/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"World Journal of Gastrointestinal Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.4240/wjgs.v17.i6.103635\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"World Journal of Gastrointestinal Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.4240/wjgs.v17.i6.103635","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景:水下内镜粘膜切除术(UEMR)自推出以来已被证明是治疗≥10mm无带蒂息肉的良好治疗选择。然而,亚洲缺乏随机对照试验(rct)。目的:比较UEMR与传统EMR (CEMR)治疗无带蒂结直肠病变的疗效和安全性。方法:于2022年10月至2024年7月在某三级医院进行随机对照试验。非带蒂结直肠肿瘤患者的大小从10毫米到30毫米被随机分配到UEMR组或CEMR组。主要观察指标为治愈性切除率(R0)。次要结果包括整体切除、手术时间、不良事件和用于缺损闭合的夹子数量。结果:共招募260例患者260个病变(UEMR组和CEMR组各130例)。中位年龄为58(27-85)岁,男女比例为1.74,中位病灶大小为20 (10-30 mm) mm。与CEMR相比,UEMR的根治性切除(R0)率显著高于CEMR (98.4% vs 90.3%;P = 0.007),整体切除率更高(100% vs 94.6%;P = 0.014),较短的手术时间(65 vs 185秒;P < 0.001),出血并发症发生率较低(1.5% vs 10%;P = 0.003),使用的夹子较少(2 vs 3;P < 0.001)。两组均未见穿孔。结论:与CEMR相比,UEMR具有更高的R0率,更大的整体切除率,更短的手术时间,更少的出血并发症,可用于治疗无带蒂结直肠肿瘤。
Underwater vs conventional endoscopic mucosal resection for nonpedunculated colorectal neoplasms: A randomized controlled trial.
Background: Underwater endoscopic mucosal resection (UEMR) has been shown to be a good treatment option for the management of nonpedunculated polyps ≥ 10 mm since its introduction. However, there is a paucity of randomized controlled trials (RCTs) in Asia.
Aim: To compare the efficacy and safety of UEMR with those of conventional EMR (CEMR) in treating nonpedunculated colorectal lesions.
Methods: We carried out this RCT at a tertiary hospital from October 2022 to July 2024. Patients with nonpedunculated colorectal neoplasms ranging from 10 mm to 30 mm in size were randomly assigned to either the UEMR or CEMR group. The primary outcome was the curative resection (R0) rate. The secondary outcomes included en bloc resection, procedure time, adverse events, and the number of clips used for defect closure.
Results: A total of 260 patients with 260 lesions (130 in each UEMR and CEMR group) were recruited. The median age was 58 (27-85) years, the male/female ratio was 1.74, and the median lesion size was 20 (10-30 mm) mm. Compared with CEMR, UEMR was associated with a significantly greater curative resection (R0) rate (98.4% vs 90.3%; P = 0.007), greater en bloc resection rate (100% vs 94.6%; P = 0.014), shorter procedure time (65 vs 185 seconds; P < 0.001), lower rate of bleeding complications (1.5% vs 10%; P = 0.003), and fewer clips used (2 vs 3; P < 0.001). No perforations were observed in either group.
Conclusion: Compared with CEMR, UEMR has a higher R0 rate, greater en bloc resection rate, shorter procedure time, fewer bleeding complications, and clips used in the management of nonpedunculated colorectal neoplasms.