Underwater endoscopic mucosal resection for 10 mm or larger nonpedunculated colorectal polyps: A systematic review and meta-analysis

Background/Aims: Recent studies have reported the favorable outcomes of underwater endoscopic mucosal resection (UEMR) for colorectal polyps. We performed a systematic review and meta-analysis evaluating the efficacy and safety of UEMR for nonpedunculated polyps ≥10 mm. Methods: We performed a comprehensive search of multiple databases (through May 2020) to identify studies reporting the outcomes of UEMR for ≥10 mm nonpedunculated colorectal polyps. The assessed outcomes were recurrence rate on the first followup, en bloc resection, incomplete resection, and adverse events after UEMR. Results: A total of 1276 polyps from 16 articles were included in our study. The recurrence rate was 7.3% (95% confidence interval [CI], 4.3.12) and 5.9% (95% CI, 3.6.9.4) for nonpedunculated polyps ≥10 and ≥20 mm, respectively. For nonpedunculated polyps .10 mm, the en bloc resection, R0 resection, and incomplete resection rates were 57.7% (95% CI, 42.4.71.6), 58.9% (95% CI, 42.4. 73.6), and 1.5% (95% CI, 0.8.2.6), respectively. The rates of pooled adverse events, intraprocedural bleeding, and delayed bleeding were 7.0%, 5.4%, and 2.9%, respectively. The rate of perforation and postpolypectomy syndrome was 0.8%. Conclusions: Our systematic review and meta-analysis demonstrates that UEMR for nonpedunculated colorectal polyps .10 mm is safe and effective with a low rate of recurrence.