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Surgical Endoscopy

, Volume 33, Issue 7, pp 2267–2273 | Cite as

Underwater polypectomy without submucosal injection for colorectal lesions ≤ 20 mm in size—a multicenter retrospective observational study

  • A. W. YenEmail author
  • A. Amato
  • S. Cadoni
  • S. Friedland
  • Y. H. Hsieh
  • J. W. Leung
  • M. Liggi
  • J. Sul
  • F. W. Leung
Article

Abstract

Background

Underwater polypectomy (UWP) of large (≥ 20 mm) colorectal lesions is well described, but reports of UWP for lesions ≤ 20 mm in size, which account for > 95% of polyps encountered in routine clinical practice, are limited. We assessed the feasibility of UWP in routine practice across various sites for colorectal lesions ≤ 20 mm in size.

Methods

A multicenter retrospective study was performed on pooled data from nine colonoscopists at 3 U.S., 1 Taiwanese and 2 Italian sites. Outcomes related to UWP on lesions ≤ 20 mm in size were analyzed.

Results

In 117 patients, UWP netted 169 lesions. Polypectomy by hot (HSP, 54%) or cold (CSP, 41%) snare, and cold forceps (CFP, 5%) were performed successfully without endoscopic evidence of residual neoplasia or immediate clinically significant adverse events. The majority (74.6%) were tubular adenomas; 60.9% were from the proximal colon. Histopathologic margins were positive in 4 and unavailable in 26 CSP and 24 HSP specimens. The remainder had negative resection margins on pathologic reports.

Conclusion

UWP for colorectal lesions ≤ 20 mm in routine practice across multiple sites confirms the feasibility and acceptability of this technique. Improvement of resection outcomes by UWP in routine practice deserves further evaluation in a randomized controlled trial.

Keywords

Polypectomy Underwater Water exchange colonoscopy 

Abbreviations

UWP

Underwater polypectomy

WE

Water exchange

HSP

Hot snare polypectomy

CSP

Cold snare polypectomy

CFP

Cold forceps polypectomy

SD

Standard deviation

RCT

Randomized controlled trial

Notes

Acknowledgements

The project described was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant Number UL1 TR001860. (AWY). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. This material is the result of work that was supported by resources from the VA Northern California Health Care System, Sacramento, California, Palo Alto VA, Palo Alto, California, and VA Greater Los Angeles Health System, Los Angeles, California. The contents reported/presented within do not represent the views of the Department of Veterans Affairs or the United States Government.

Compliance with ethical standards

Disclosures

Drs. Yen, Amato, Cadoni, Friedland, Hsieh, J. Leung, Liggi, Sul and F. Leung have no conflicts of interest or financial ties to disclose.

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Copyright information

© This is a U.S. government work and its text is not subject to copyright protection in the United States; however, its text may be subject to foreign copyright protection 2018

Authors and Affiliations

  • A. W. Yen
    • 1
    • 2
    Email author
  • A. Amato
    • 3
  • S. Cadoni
    • 4
  • S. Friedland
    • 5
    • 6
  • Y. H. Hsieh
    • 7
    • 8
  • J. W. Leung
    • 1
    • 2
  • M. Liggi
    • 4
  • J. Sul
    • 9
    • 10
  • F. W. Leung
    • 10
    • 11
  1. 1.Division of GastroenterologySacramento VA Medical Center, VANCHCSMatherUSA
  2. 2.University of California Davis School of MedicineSacramentoUSA
  3. 3.Division of GastroenterologyValduce HospitalComoItaly
  4. 4.Digestive Endoscopy UnitS. Barbara HospitalIglesiasItaly
  5. 5.Division of GastroenterologyPalo Alto VAMCPalo AltoUSA
  6. 6.Stanford UniversityPalo AltoUSA
  7. 7.Division of GastroenterologyDalin Tzu Chi Hospital, Buddhist Tzu Chi Medical FoundationHualienTaiwan, Republic of China
  8. 8.Tzu Chi UniversityHualienTaiwan, Republic of China
  9. 9.Division of GastroenterologyWest Los Angeles VAMC, VAGLAHSLos AngelesUSA
  10. 10.David Geffen School of Medicine at UCLALos AngelesUSA
  11. 11.Division of GastroenterologyVAGLAHSNorth HillUSA

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