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New research · Gastroenterology
Journal of gastrointestinal and liver diseases : JGLD · 2d
Systematic reviewJournal of gastrointestinal and liver diseases : JGLD · 2026

Clinical Outcomes of Underwater versus Conventional Endoscopic Mucosal Resection in the Removal of Sessile or Flat Colorectal Polyps ≥10 mm: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Yiheng Yao, Jinfeng Chi, Zhihan Wang … Liang Liu
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GastroenterologySystematic review

Underwater EMR improves complete polyp removal compared to conventional EMR.

Clinical Outcomes of Underwater versus Conventional Endoscopic Mucosal Resection in the Removal of Sessile or Flat Colorectal Polyps ≥10 mm: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Yiheng Yao et al. · Journal of gastrointestinal and liver diseases : JGLD · 2026
Background

Underwater endoscopic mucosal resection (U-EMR) and conventional endoscopic mucosal resection (C-EMR) are the primary techniques for the removal of colorectal polyps.

Purpose

The purpose of this study is to conduct a meta-analysis on the safety and efficacy of the two procedures, U-EMR and C-EMR.

Methods

We searched multiple databases for randomized controlled trials (RCTs) comparing U-EMR and C-EMR for the resection of sessile or flat colorectal polyps.

Results

Underwater EMR leads to a higher rate of complete polyp removal

RR by subgroup · 95% CI
null = 1
mainly manifested in 10-20 mm polyps
1.16
U-EMR outperformed C-EMR
1.28
More results

Regarding the en bloc resection rate, U-EMR was superior to C-EMR [Risk Ratio (RR) 1.13, 95% confidence interval (CI): 1.02-1.24].

Subgroup analysis showed that the higher en bloc resection rate of U-EMR was mainly manifested in 10-20 mm polyps (RR=1.16, 95%CI: 1.07-1.25).

More results

In terms of the incidence of adverse events and recurrence rate, U-EMR showed a trend lower than C-EMR in terms of intraoperative bleeding [odds ratio (OR) 0.83, 95%CI: 0.45-1.54), delayed bleeding (OR=0.61, 95%CI: 0.28-1.32), and recurrence rate (OR=0.53, 95%CI: 0.24-1.18), but none of them reached statistical significance.

“
Conclusion

For sessile or flat colorectal polyps measuring ≥10 mm in diameter, U-EMR demonstrates superior efficacy compared with C-EMR.

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