{"title":"WEO Newsletter: Tips and tricks for underwater resection. How to swim without drowning in this technique","authors":"","doi":"10.1111/den.14877","DOIUrl":null,"url":null,"abstract":"<p>WEO Newsletter Editor: Nalini M Guda MD, MASGE, AGAF, FACG, FJGES</p><p>Luciano Lenz and Fauze Maluf-Filho</p><p><i>“Water is the principle of all things”</i>.</p><p>Thales of Miletus (c. 620 B.C.E. – c. 546 B.C.E.)</p><p>Thales investigated almost all areas of knowledge. Aristotle defined him as the first philosopher. Today, he is also considered by many to be the pioneer of scientific thought.</p><p>Colorectal cancer is the third most common malignancy and the second most common cause of death. In the attempt to change this scenario, colonoscopy is the best tool for the diagnosis and prevention of colorectal cancer. Endoscopic removal of polyps reduces the incidence of colorectal cancer by up to 90%.1 Most polyps are small and can be easily treated with conventional polypectomy. However, larger nonpedunculated lesions present a technical challenge.</p><p>Conventional endoscopic mucosal resection (CEMR) is the currently accepted standard of care. CEMR uses submucosal injection of a solution to separate the superficial layers from the deep submucosa and the muscularis propria. In theory, this reduces the risk of thermal injury to the deeper tissue layers and iatrogenic perforation. Conversely, submucosal injection may paradoxically make snare capture of a flat polyp more difficult. Another major concern after CEMR is the risk of recurrence detected on follow-up colonoscopy. Rates of 15% to 50% of recurrent lesions have been reported in several CEMR series.</p><p>To overcome these limitations, Binmoeller et al. conceived an alternative way to remove the lesion without submucosal injection. Since their first description of underwater EMR (UEMR) in 2012, many articles have been published indicating acceptable rates of technical success and a low incidence of adverse events (AE) with UEMR and even a lower recurrence rate than CEMR.</p><p>Even with such compelling evidence, many endoscopists are reluctant to perform underwater polyp resection. This article highlights the useful clinical tips for successful underwater resection of colon polyps.</p><p>Finally start soon, don't be outdated. Don't be the last to dive into the aquatic world of endoscopy.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 7","pages":"861-865"},"PeriodicalIF":5.0000,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14877","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Digestive Endoscopy","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/den.14877","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
Thales investigated almost all areas of knowledge. Aristotle defined him as the first philosopher. Today, he is also considered by many to be the pioneer of scientific thought.
Colorectal cancer is the third most common malignancy and the second most common cause of death. In the attempt to change this scenario, colonoscopy is the best tool for the diagnosis and prevention of colorectal cancer. Endoscopic removal of polyps reduces the incidence of colorectal cancer by up to 90%.1 Most polyps are small and can be easily treated with conventional polypectomy. However, larger nonpedunculated lesions present a technical challenge.
Conventional endoscopic mucosal resection (CEMR) is the currently accepted standard of care. CEMR uses submucosal injection of a solution to separate the superficial layers from the deep submucosa and the muscularis propria. In theory, this reduces the risk of thermal injury to the deeper tissue layers and iatrogenic perforation. Conversely, submucosal injection may paradoxically make snare capture of a flat polyp more difficult. Another major concern after CEMR is the risk of recurrence detected on follow-up colonoscopy. Rates of 15% to 50% of recurrent lesions have been reported in several CEMR series.
To overcome these limitations, Binmoeller et al. conceived an alternative way to remove the lesion without submucosal injection. Since their first description of underwater EMR (UEMR) in 2012, many articles have been published indicating acceptable rates of technical success and a low incidence of adverse events (AE) with UEMR and even a lower recurrence rate than CEMR.
Even with such compelling evidence, many endoscopists are reluctant to perform underwater polyp resection. This article highlights the useful clinical tips for successful underwater resection of colon polyps.
Finally start soon, don't be outdated. Don't be the last to dive into the aquatic world of endoscopy.
期刊介绍：
Digestive Endoscopy (DEN) is the official journal of the Japan Gastroenterological Endoscopy Society, the Asian Pacific Society for Digestive Endoscopy and the World Endoscopy Organization. Digestive Endoscopy serves as a medium for presenting original articles that offer significant contributions to knowledge in the broad field of endoscopy. The Journal also includes Reviews, Original Articles, How I Do It, Case Reports (only of exceptional interest and novelty are accepted), Letters, Techniques and Images, abstracts and news items that may be of interest to endoscopists.
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