Efficacy of water pressure method for colorectal endoscopic submucosal dissection: Propensity-score matching analysis

 

 Permissions and Reprints

Abstract

Background and study aims

Technical difficulty of endoscopic submucosal dissection (ESD) for colorectal neoplasms has not been resolved. The water pressure method (WPM) is a helpful technique for overcome difficulties with colorectal ESD. We evaluated the efficacy and safety of ESD with WPM (WPM-ESD) for colorectal neoplasms compared with conventional ESD (C-ESD).

Patients and methods

This was a single-center, retrospective, observational study. Three hundred and eleven colorectal lesions were allocated into the WPM-ESD and the C-ESD groups, which were compared before and after propensity score matching. The main outcomes were procedure time, proportion of R0 resection, and incidence of adverse events (AEs) in the two groups.

Results

The WPM-ESD and C-ESD groups were allocated 134 and 177 lesions, respectively, and propensity score matching analysis created 92 matched pairs. Mean procedure time was significantly shorter in the WPM-ESD group (49 ± 26 vs. 58 ± 42 min, P = 0.032). All lesions were resected in one piece and there was no difference in the proportion of en bloc resection (100% vs. 100%) and R0 resection (92% vs. 96%, P = 0.536) or in incidence of intraoperative perforation (2.2% vs. 2.2%) in the two groups.

Conclusions

WPM for colorectal ESD may shorten procedure time compared with C-ESD without increasing AEs.

Publication History

Received: 15 August 2024

Accepted after revision: 14 February 2025

Accepted Manuscript online:
21 February 2025

Article published online:
04 April 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

• References

• 1 Ohata K, Kobayashi N, Sakai E. et al. Long-term outcomes after endoscopic submucosal dissection for large colorectal epithelial neoplasms: A prospective, multicenter, cohort trial from Japan. Gastroenterology 2022; 163: 1423-1434 e1422
  Search in Google Scholar
• 2 Kobayashi N, Takeuchi Y, Ohata K. et al. Outcomes of endoscopic submucosal dissection for colorectal neoplasms: Prospective, multicenter, cohort trial. Dig Endosc 2022; 34: 1042-1051
  Search in Google Scholar
• 3 Binmoeller KF, Shah JN, Bhat YM. et al. “Underwater” EMR of sporadic laterally spreading nonampullary duodenal adenomas (with video). Gastrointest Endosc 2013; 78: 496-502.e491
  Search in Google Scholar
• 4 Uedo N, Nemeth A, Johansson G. et al. Underwater endoscopic mucosal resection of large colorectal lesions. Endoscopy 2014; 47: 172-174
  Search in Google Scholar
• 5 Yamashina T, Uedo N, Akasaka T. et al. Comparison of underwater vs conventional endoscopic mucosal resection of intermediate-size colorectal polyps. Gastroenterology 2019; 157: 451-461 e452
  Search in Google Scholar
• 6 Garg R, Singh A, Mohan BP. et al. Underwater versus conventional endoscopic mucosal resection for colorectal lesions: a systematic review and meta-analysis. Endosc Int Open 2020; 08: E1884-E1894
  Search in Google Scholar
• 7 Nagl S, Ebigbo A, Goelder SK. et al. Underwater vs conventional endoscopic mucosal resection of large sessile or flat colorectal polyps: A prospective randomized controlled trial. Gastroenterology 2021; 161: 1460-1474.e146
  Search in Google Scholar
• 8 Choi AY, Moosvi Z, Shah S. et al. Underwater versus conventional EMR for colorectal polyps: systematic review and meta-analysis. Gastrointest Endosc 2021; 93: 378-389
  Search in Google Scholar
• 9 Chandan S, Bapaye J, Khan SR. et al. Safety and efficacy of underwater versus conventional endoscopic mucosal resection for colorectal polyps: Systematic review and meta-analysis of RCTs. Endosc Int Open 2023; 11: E768-E777
  Search in Google Scholar
• 10 Yoshii S, Hayashi Y, Matsui T. et al. "Underwater" endoscopic submucosal dissection: a novel technique for complete resection of a rectal neuroendocrine tumor. Endoscopy 2016; 48: E67-E68
  Search in Google Scholar
• 11 Akasaka T, Takeuchi Y, Uedo N. et al. “Underwater” endoscopic submucosal dissection for superficial esophageal neoplasms. Gastrointest Endosc 2017; 85: 251-252
  Search in Google Scholar
• 12 Nagata M. Usefulness of underwater endoscopic submucosal dissection in saline solution with a monopolar knife for colorectal tumors (with videos). Gastrointest Endosc 2018; 87: 1345-1353
  Search in Google Scholar
• 13 Yahagi N, Nishizawa T, Sasaki M. et al. Water pressure method for duodenal endoscopic submucosal dissection. Endoscopy 2017; 49: E227-E228
  Search in Google Scholar
• 14 Yoshii S, Akasaka T, Hayashi Y. et al. “Underwater” endoscopic submucosal dissection: a novel method for resection in saline with a bipolar needle knife for colorectal epithelial neoplasia. Surg Endosc 2018; 32: 5031-5036
  Search in Google Scholar
• 15 Harada H, Nakahara R, Murakami D. et al. Saline-pocket endoscopic submucosal dissection for superficial colorectal neoplasms: a randomized controlled trial (with video). Gastrointest Endosc 2019; 90: 278-287
  Search in Google Scholar
• 16 Cecinato P, Bassi F, Sereni G. et al. Underwater endoscopic submucosal dissection of a non-granular laterally spreading tumor of the hepatic flexure. Endoscopy 2020; 52: E426-E427
  Search in Google Scholar
• 17 Kato M, Takatori Y, Sasaki M. et al. Water pressure method for duodenal endoscopic submucosal dissection (with video). Gastrointest Endosc 2021; 93: 942-949
  Search in Google Scholar
• 18 Ozeki Y, Hirasawa K, Ikeda R. et al. Safety and efficacy of water pressure endoscopic submucosal dissection for colorectal tumors with submucosal fibrosis (with video). Gastrointest Endosc 2021; 94: 607-617 e602
  Search in Google Scholar
• 19 Miyazaki K, Kato M, Kanai T. et al. A successful case of endoscopic submucosal dissection using the water pressure method for early gastric cancer with severe fibrosis. VideoGIE 2022; 7: 219-222
  Search in Google Scholar
• 20 Masunaga T, Kato M, Sasaki M. et al. Effectiveness of water pressure method in colorectal endoscopic submucosal dissection by novice endoscopists. Endosc Int Open 2023; 11: E641-E648
  Search in Google Scholar
• 21 Koyama Y, Fukuzawa M, Aikawa H. et al. Underwater endoscopic submucosal dissection for colorectal tumors decreases the incidence of post-electrocoagulation syndrome. J Gastroenterol Hepatol 2023; 38: 1566-1575
  Search in Google Scholar
• 22 Tanaka S, Kashida H, Saito Y. et al. JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Digest Endosc 2015; 27: 417-434
  Search in Google Scholar
• 23 Matsumoto A, Tanaka S, Oba S. et al. Outcome of endoscopic submucosal dissection for colorectal tumors accompanied by fibrosis. Scand J Gastroenterol 2010; 45: 1329-1337
  Search in Google Scholar
• 24 Oh CK, Chung HH, Park JK. et al. Comparing underwater endoscopic submucosal dissection and conventional endoscopic submucosal dissection for large laterally spreading tumor: a randomized controlled trial (with video). Gastrointest Endosc 2024; 100: 1079-1087.e1
  Search in Google Scholar
• 25 Nagata M, Namiki M, Fujikawa T. et al. Prospective randomized trial comparing conventional and underwater endoscopic submucosal dissection for superficial colorectal neoplasms. Endoscopy 2024;
  Search in Google Scholar
• 26 Toyonaga T, Man-i M, Fujita T. et al. Retrospective study of technical aspects and complications of endoscopic submucosal dissection for laterally spreading tumors of the colorectum. Endoscopy 2010; 42: 714-722
  Search in Google Scholar
• 27 Kim E, Cho K, Park K. et al. Factors predictive of perforation during endoscopic submucosal dissection for the treatment of colorectal tumors. Endoscopy 2011; 43: 573-578
  Search in Google Scholar
• 28 Hong SN, Byeon JS, Lee I B-. et al. Prediction model and risk score for perforation in patients undergoing colorectal endoscopic submucosal dissection. Gastrointest Endosc 2016; 84: 98-108
  Search in Google Scholar
• 29 Cecinato P, Lucarini M, Campanale C. et al. Underwater endoscopic submucosal dissection and hybrid endoscopic submucosal dissection as rescue therapy in difficult colorectal cases. Endosc Int Open 2022; 10: E1225-E1232
  Search in Google Scholar
• 30 Sakamoto N, Osada T, Shibuya T. et al. The facilitation of a new traction device (S-O clip) assisting endoscopic submucosal dissection for superficial colorectal neoplasms. Endoscopy 2008; 40: E94-E95
  Search in Google Scholar
• 31 Ritsuno H, Sakamoto N, Osada T. et al. Prospective clinical trial of traction device-assisted endoscopic submucosal dissection of large superficial colorectal tumors using the S-O clip. Surg Endosc 2014; 28: 3143-3149
  Search in Google Scholar
• 32 Yamasaki Y, Takeuchi Y, Uedo N. et al. Efficacy of traction-assisted colorectal endoscopic submucosal dissection using a clip-and-thread technique: A prospective randomized study. Dig Endosc 2018; 30: 467-476
  Search in Google Scholar
• 33 Min BH, Chang DK, Kim DU. et al. Low frequency of bacteremia after an endoscopic resection for large colorectal tumors in spite of extensive submucosal exposure. Gastrointest Endosc 2008; 68: 105-110
  Search in Google Scholar
• 34 Lee SP, Sung IK, Kim JH. et al. A randomized controlled trial of prophylactic antibiotics in the prevention of electrocoagulation syndrome after colorectal endoscopic submucosal dissection. Gastrointest Endosc 2017; 86: 349-357 e342
  Search in Google Scholar
• 35 Tomioka A, Narimatsu K, Chiya N. et al. Hepatic portal venous gas and bacteremia after colonic endoscopic submucosal dissection: A case report. DEN Open 2022; 2: e107
  Search in Google Scholar