Le QD, Le NQ, Quach DT. Underwater vs conventional endoscopic mucosal resection for nonpedunculated colorectal neoplasms: A randomized controlled trial. World J Gastrointest Surg 2025; 17(6): 103635 [DOI: 10.4240/wjgs.v17.i6.103635]
Corresponding Author of This Article
Duc T Quach, PhD, Associate Professor, Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Hong Bang Street, Ho Chi Minh City 70000, Viet Nam. drquachtd@ump.edu.vn
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Randomized Controlled Trial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Jun 27, 2025; 17(6): 103635 Published online Jun 27, 2025. doi: 10.4240/wjgs.v17.i6.103635
Underwater vs conventional endoscopic mucosal resection for nonpedunculated colorectal neoplasms: A randomized controlled trial
Quang D Le, Nhan Q Le, Duc T Quach
Quang D Le, Duc T Quach, Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 70000, Viet Nam
Nhan Q Le, Department of Gastrointestinal Endoscopy, University Medical Center at Ho Chi Minh City, Ho Chi Minh City 70000, Viet Nam
Author contributions: Quach DT and Le QD initiated the study, designed the research, supervised the study, performed the statistical analyses, interpreted the data, and wrote and critically revised the manuscript; Le QD and Le NQ contributed to the data acquisition; Le QD submitted the study; All authors approved the final version of the draft.
Institutional review board statement: The Institutional Review Board of the University of Medicine and Pharmacy at Ho Chi Minh City approved the study (No. IRB-VN01002/IORG0008603/FWA00023448).
Clinical trial registration statement: This study is registered at https://clinicaltrials.gov/. The registration identification number is No. NCT05825664.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: Technical appendix, statistical code and dataset available from the corresponding author at drquachtd@ump.edu.vn. The participants provided informed consent for data sharing.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Duc T Quach, PhD, Associate Professor, Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Hong Bang Street, Ho Chi Minh City 70000, Viet Nam. drquachtd@ump.edu.vn
Received: November 26, 2024 Revised: March 23, 2025 Accepted: April 21, 2025 Published online: June 27, 2025 Processing time: 185 Days and 20.9 Hours
Abstract
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.
Core Tip: This randomized controlled trial compared underwater endoscopic mucosal resection (UEMR) and conventional EMR for nonpedunculated colorectal neoplasms (10-30 mm). UEMR demonstrated superior outcomes, including a significantly higher curative resection (R0) rate (98.4% vs 90.3%; P = 0.007), greater en bloc resection (100% vs 94.6%; P = 0.014), shorter procedure time (65 vs 185 seconds; P < 0.001), reduced bleeding risk (1.5% vs 10%; P = 0.003), and fewer hemostatic clips used (2 vs 3; P < 0.001). These findings indicate that UEMR is a safer and more effective technique for managing nonpedunculated colorectal neoplasms.
