Resident Cleveland Clinic Foundation Cleveland, OH
Award: Presidential Poster Award
Rajat Garg, MD1, Amandeep Singh, MD2, Manik Aggarwal, MD2, Jaideep Bhalla, MBBS3, Babu P. Mohan, MBBS, MD4, Carol A. Burke, MD, FACG1, Prabhleen Chahal, MD1; 1Cleveland Clinic Foundation, Cleveland, OH; 2Cleveland Clinic, Cleveland, OH; 3Maulana Azad Medical College, New Delhi, Delhi, India; 4University of Utah, Salt Lake City, UT
Introduction: Recent studies have reported positive outcome of underwater endoscopic mucosal resection (UEMR) for the resection of colorectal polyps. We conducted a systematic review and meta-analysis studying efficacy and safety of UEMR for the resection of non-pedunculated polyps ≥10 millimeters (mm) in size. Methods: We performed a comprehensive search of multiple databases (through May 2020) to identify studies that reported outcome of UEMR for colorectal non-pedunculated polyps ≥10 mm. Outcomes assessed included adverse events, intra-procedural bleeding, delayed bleeding, perforation, post-polypectomy syndrome, incomplete resection, en bloc resection and rate of recurrence after UEMR. We also performed subgroup analysis of non-pedunculated polyps ≥20 mm. All analyses was performed using R statistical software (metafor package). Results: A total of 1,276 polyps from 16 studies were included in our analysis. The mean age and polyp size ranged from 54.5 to 75.0 years and 9.9 mm to 38.0 mm, respectively. Rates of pooled adverse events, intra-procedural and delayed bleeding were 6.9% (95% confidence interval [CI] 4.6-10.3), 5.4% (95% CI, 3.3-8.7) and 2.9% (95% CI, 2.0-4.1), respectively (Figure 1a, 1b and 1c). There was only one case of perforation and post-polypectomy syndrome each, with pooled rate of 0.8% (95% CI, 0.4-1.6) (figure 1d). The en bloc resection, R0 resection and incomplete resection rates were 57.6% (95% CI, 42.4-71.6), 58.9% (95% CI, 42.4-73.6) and 1.5% (95% CI, 0.8-2.6), respectively (Figure 2a, 2b and 2c). Ten studies with a total of 489 non-pedunculated polyps ≥20 mm reported outcomes of UEMR. The recurrence rates on first follow up were 7.3% (95% CI, 4.3-12) and 5.9% (95% CI, 3.6-9.4%) for non-pedunculated polyps ≥10 mm (Figure 2d) and ≥20 mm, respectively. The pooled rate of any adverse events, intra-procedural and delayed bleeding was 12.5% (95% CI, 6.5% – 22.5%, I2=55), 10.5% (95% CI, 5.2 – 20.1, I2=56.5), and 2.5% (95% CI, 1.3 – 4.6, I2=0), respectively. All the results are also summarized in Table 1. On meta-regression, proximal location of polyp was positive predictor of adverse events (p=0.02) and intra-procedural bleeding (p=0.01). Discussion: Our systematic review and meta-analysis demonstrates that UEMR for non-pedunculated colorectal polyps of size ≥10 mm is safe and effective with low rate of recurrence.
Figure 1: Forest plot showing rates of adverse events (A), intra-procedural bleeding (B), delayed bleeding (C) and perforation (D) of UEMR for non-pedunculated polyps ≥ 10 mm.
Figure 2: Forest plot showing pooled rates of en bloc resection (A), R0 resection (B), incomplete resection (C), and recurrence (D) of non-pedunculated polyps ≥ 10 mm after UEMR.
Disclosures: Rajat Garg indicated no relevant financial relationships. Amandeep Singh indicated no relevant financial relationships. Manik Aggarwal indicated no relevant financial relationships. Jaideep Bhalla indicated no relevant financial relationships. Babu Mohan indicated no relevant financial relationships. Carol Burke indicated no relevant financial relationships. Prabhleen Chahal indicated no relevant financial relationships.