BACKGROUND Underwater endoscopic mucosal resection(UEMR)has been shown to be a good treatment option for the management of nonpedunculated polyps≥10 mm since its introduction.However,there is a paucity of randomized ...BACKGROUND Underwater endoscopic mucosal resection(UEMR)has been shown to be a good treatment option for the management of nonpedunculated polyps≥10 mm since its introduction.However,there is a paucity of randomized controlled trials(RCTs)in Asia.AIM To compare the efficacy and safety of UEMR with those of conventional EMR(CEMR)in treating nonpedunculated colorectal lesions.METHODS We carried out this RCT at a tertiary hospital from October 2022 to July 2024.Patients with nonpedunculated colorectal neoplasms ranging from 10 mm to 30 mm in size were randomly assigned to either the UEMR or CEMR group.The primary outcome was the curative resection(R0)rate.The secondary outcomes included en bloc resection,procedure time,adverse events,and the number of clips used for defect closure.RESULTS A total of 260 patients with 260 lesions(130 in each UEMR and CEMR group)were recruited.The median age was 58(27-85)years,the male/female ratio was 1.74,and the median lesion size was 20(10-30 mm)mm.Compared with CEMR,UEMR was associated with a significantly greater curative resection(R0)rate(98.4%vs 90.3%;P=0.007),greater en bloc resection rate(100%vs 94.6%;P=0.014),shorter procedure time(65 vs 185 seconds;P<0.001),lower rate of bleeding complications(1.5%vs 10%;P=0.003),and fewer clips used(2 vs 3;P<0.001).No perforations were observed in either group.CONCLUSION Compared with CEMR,UEMR has a higher R0 rate,greater en bloc resection rate,shorter procedure time,fewer bleeding complications,and clips used in the management of nonpedunculated colorectal neoplasms.展开更多
Objective:To explore the clinical feasibility and safety of modified endoscopic mucosal resection for rectal neuroendocrine tumors(R-NETs).Methods:Seventy cases of R-NETs treated with endoscopic mucosal resection in o...Objective:To explore the clinical feasibility and safety of modified endoscopic mucosal resection for rectal neuroendocrine tumors(R-NETs).Methods:Seventy cases of R-NETs treated with endoscopic mucosal resection in our hospital between April 2022 and March 2024 were selected and divided into the control group and the observation group using the mean score method,each with 35 cases.In the control group,traditional endoscopic mucosal resection(EMR)was performed,and in the observation group,modified EMR(endoscopic mucosal resection with ligation apparatus[EMR-L])was performed.The operation time,hospitalization time,operation cost,and related complication rate of the two groups of patients were compared.Results:The operation time(20.36±1.46 min)and hospital stay(3.37±0.51 d)of patients in the observation group were shorter than those of the control group(31.44±2.65 min and 4.73±0.49 d).The cost of the operation in the observation group(7,695.85±1,521.42 yuan)was lower than that of the control group(8,418.62±1219.30 yuan),and the difference was statistically significant(P<0.05).The total incidence of postoperative related complications in the observation group was observed to be 11.42%,which was significantly lower than that of 31.42%in the control group,and the difference was statistically significant(P<0.05).Conclusion:The application of modified EMR in R-NETs is remarkable,which can not only effectively shorten the operation time and hospital stay,but also further reduce the risk of related complications,and indirectly save a large amount of hospital costs;thus,it is recommended to be promoted and applied clinically.展开更多
Colorectal cancer remains a major health concern,with colorectal polyps as key precursors.Endoscopic mucosal resection(EMR)is a common treatment,but recurrence rates remain high.Traditional surveillance strategies rel...Colorectal cancer remains a major health concern,with colorectal polyps as key precursors.Endoscopic mucosal resection(EMR)is a common treatment,but recurrence rates remain high.Traditional surveillance strategies rely on polyp characteristics and completeness of the resection potentially missing key risk factors.Machine learning(ML)offers a transformative approach by integrating patient-specific data to refine risk stratification.Recent studies highlight ML models,such as Extreme Gradient Boosting,which outperform conventional methods in predicting polyp recurrence within one-year post-EMR.These models incorporate factors like age,smoking status,family history,and pathology,optimizing follow-up recommendations and minimizing unnecessary procedures.Artificial intelligence(AI)-driven tools and web-based calculators enhance clinical workflow by providing real-time,personalized risk assessments.However,challenges remain in external validation,model interpretability,and clinical integration.Future surveillance strategies should combine expert judgment with AI insights to optimize patient outcomes.As gastroenterology embraces AI,MLdriven surveillance represents a paradigm shift,advancing precision medicine in colorectal polyp management.This editorial explores AI’s role in transforming post-EMR follow-up,addressing benefits,limitations,and future directions.展开更多
In 2025,Shi et al constructed a model utilizing machine learning techniques to predict the one-year recurrence of colorectal polyps following endoscopic mucosal resection,showing excellent discriminatory performance w...In 2025,Shi et al constructed a model utilizing machine learning techniques to predict the one-year recurrence of colorectal polyps following endoscopic mucosal resection,showing excellent discriminatory performance with an area under the curve exceeding 0.90.However,limitations exist regarding its narrow temporal scope,potential overestimation due to feature collinearity and imputation opacity,and limited generalizability due to single-center derivation and validation.Moreover,no clear clinical implementation strategy was outlined.Prospective multicenter validation and integration of endoscopist variability,longitudinal outcome data,and deployment mechanisms are warranted to ensure broader applicability and clinical utility.展开更多
BACKGROUND Although substantial evidence supports the advantages of cold snare polypectomy(CSP)in terms of polypectomy efficacy and reduced postoperative adverse events,few studies have examined the cost differences b...BACKGROUND Although substantial evidence supports the advantages of cold snare polypectomy(CSP)in terms of polypectomy efficacy and reduced postoperative adverse events,few studies have examined the cost differences between CSP and traditional endoscopic mucosal resection(EMR)for the treatment of intestinal polyps.AIM To compare the efficacy-cost of EMR and CSP in the treatment of intestinal polyps.METHODS A total of 100 patients with intestinal polyps were included in the retrospective data of our hospital from April 2022 to May 2023.According to the treatment methods,they were divided into EMR(n=46)group and CSP(n=54)group.The baseline data of the two groups were balanced by 1:1 propensity score matching(PSM),and the cost-effectiveness analysis was performed on the two groups after matching.The recurrence rate of the two groups of patients was followed up for 1 year,and they were divided into recurrence group and non-recurrence group according to whether they recurred.Multivariate logistic regression analysis was used to screen out the influencing factors affecting the recurrence of intestinal polyps after endoscopic resection.RESULTS Significant disparities were observed in the number of polyps and smoking background between the two groups before PSM(P<0.05).Following PSM,the number of polyps and smoking history were well balanced between the EMR and CSP groups.The direct cost incurred by the CSP group was markedly higher than that incurred by the EMR group.Concurrently,the cost-effectiveness ratio in the CSP group was substantially reduced when juxtaposed with that in the EMR group(P<0.05).Upon completion of the 1-year follow-up,the rate of recurrence after endoscopic intestinal polypectomy was 38.00%.Multivariate methods revealed that age≥60 years,male sex,number of polyps≥3,and pathological type of adenoma were risk factors for recurrence after endoscopic intestinal polypectomy(all P<0.05).CONCLUSION CSP was more cost-effective for the treatment of intestinal polyps.An age≥60 years,male sex,having a number of polyps≥3,and pathological type of adenoma are independent influencing factors for recurrence.展开更多
The machine learning model developed by Shi et al for predicting colorectal polyp recurrence after endoscopic mucosal resection represents a significant advancement in the field of clinical gastroenterology.By integra...The machine learning model developed by Shi et al for predicting colorectal polyp recurrence after endoscopic mucosal resection represents a significant advancement in the field of clinical gastroenterology.By integrating patient-specific factors,such as age,smoking history,and Helicobacter pylori infection,the eXtreme Gradient Boosting algorithm enables precise personalised colonoscopy follow-up planning and risk assessment.This predictive tool offers substantial benefits by optimising surveillance intervals and directing healthcare resources more efficiently toward high-risk individuals.However,real-world implementation requires consideration of the generalisability of our findings across diverse patient populations and clinician training backgrounds.展开更多
BACKGROUND In recent years,endoscopic anti-reflux mucosal resection(ARMS)has demonstrated benefits,including good efficacy,ease of operation,low cost,and fewer complications;however,it is still in the exploratory stag...BACKGROUND In recent years,endoscopic anti-reflux mucosal resection(ARMS)has demonstrated benefits,including good efficacy,ease of operation,low cost,and fewer complications;however,it is still in the exploratory stage.AIM To evaluate the clinical efficacy of ARMS in patients with gastroesophageal reflux disease(GERD)and its effects on the gut microbiota.METHODS This single-center,retrospective,self-controlled study included 80 patients with GERD.All patients underwent endoscopic ARMS and were followed for at least 3 months after surgery.The primary outcome measures were changes in the gut microbiota before and after treatment and clinical efficacy.RESULTS After surgery,the counts of Escherichia coli and Staphylococcus aureus were significantly lower than those before surgery(P<0.05),whereas the counts of Bifidobacterium and Lactobacillus were significantly higher than those before surgery(P<0.05).Symptoms,such as reflux and heartburn,were markedly relieved postoperatively.The average Gerd Q score prior to surgery was 11.32±1.26 points,which decreased to 5.89±0.52 points 3 months after surgery.All patients used proton pump inhibitors before surgery,and the proportion of patients using proton pump inhibitors declined significantly postoperatively.Sixteen patients(20.0%)experienced surgery-related adverse reactions within 2 weeks to 1 month post-surgery.The incidence rates of postoperative esophageal stricture and delayed bleeding were 15.0%and 5.0%,respectively.CONCLUSION Endoscopic ARMS can effectively alleviate reflux symptoms,maintain gut microbiota balance,and improve gastrointestinal function in patients with GERD.展开更多
Objective:To analyze the application value of modified endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)in rectal neuroendocrine tumors,with a view to providing new clinical options for the ea...Objective:To analyze the application value of modified endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)in rectal neuroendocrine tumors,with a view to providing new clinical options for the early diagnosis and treatment of patients with such tumors,and thus improving their prognosis.Methods:Seventy-two patients with rectal neuroendocrine tumors who underwent surgical treatment in a hospital between October 2023 and September 2024 were selected and divided into a control group and an observation group using the mean score method,each with 36 cases.In the control group,traditional foreign body forceps combined with laparoscopic resection were performed,and in the observation group,modified EMR and ESD were performed as needed.The mass resection rate,histologically intact resection rate,postoperative serum vascular endothelial growth factors(VEGFA,VEGFB,VEGFC levels)in the postoperative period of 7d,and indicators of the rate of related complications of the two groups of patients were compared.Results:The mass resection rate of 91.67%and histological complete resection rate of 94.44%in the observation group were significantly higher than those of 72.22%and 66.67%in the control group;the VEGFA,VEGFB,and VEGFC levels of the observation group were 82.08±7.94 ng/ml,168.89±16.53 ng/ml,and 121.07±10.75 ng/ml,respectively,in the postoperative period of 7 d after surgery;the levels were significantly higher than those of the control group:68.39±6.82 ng/ml,141.06±14.12 ng/ml,and 98.45±9.87 ng/ml,respectively,and the difference was statistically significant(P<0.05);the patients in the observation group had a lower rate of surgical complications than those in the control group(2.78%vs 8.33%),the difference was not statistically significant(P>0.05).Conclusion:Modified EMR and ESD in rectal neuroendocrine tumors are effective,not only can it effectively improve the rate of mass resection and histological integrity of the resection rate,but it can also further improve the level of serum vascular endothelial growth factor(VEGFA,VEGFB,VEGFC);thus,it is recommended to be promoted for use in clinical practice.展开更多
BACKGROUND Duodenal Brunner's gland hyperplasia(BGH)is a therapeutic target when complications such as bleeding or gastrointestinal obstruction occur or when malignancy cannot be ruled out.Herein,we present a case...BACKGROUND Duodenal Brunner's gland hyperplasia(BGH)is a therapeutic target when complications such as bleeding or gastrointestinal obstruction occur or when malignancy cannot be ruled out.Herein,we present a case of large BGH treated with endoscopic mucosal resection(EMR).CASE SUMMARY An 83-year-old woman presented at our hospital with dizziness.Blood tests revealed severe anemia,esophagogastroduodenoscopy showed a 6.5 cm lesion protruding from the anterior wall of the duodenal bulb,and biopsy revealed the presence of glandular epithelium.Endoscopic ultrasonography(EUS)demonstr-ated relatively high echogenicity with a cystic component.The muscularis propria was slightly elevated at the base of the lesion.EMR was performed without complications.The formalin-fixed lesion size was 6 cm×3.5 cm×3 cm,showing nodular proliferation of non-dysplastic Brunner's glands compartmentalized by fibrous septa,confirming the diagnosis of BGH.Reports of EMR or hot snare polypectomy are rare for duodenal BGH>6 cm.In this case,the choice of EMR was made by obtaining information on the base of the lesion as well as on the internal characteristics through EUS.CONCLUSION Large duodenal lesions with good endoscopic maneuverability and no evident muscular layer involvement on EUS may be resectable via EMR.展开更多
BACKGROUND Underwater endoscopic mucosal resection(UEMR)of colorectal lesions is emerging as an alternative method to conventional endoscopic mucosal resection(EMR);however,it is still controversial whether there is a...BACKGROUND Underwater endoscopic mucosal resection(UEMR)of colorectal lesions is emerging as an alternative method to conventional endoscopic mucosal resection(EMR);however,it is still controversial whether there is a difference in the effectiveness between UEMR and EMR.AIM To evaluate the effectiveness and safety of UEMR in the treatment of colorectal polyps.METHODS Clinical studies comparing the effectiveness or safety of UEMR in the treatment of colorectal polyps were searched in medical databases,including Pub Med,Embase,Cochrane Library,CNKI,and Wanfang Data,monographs,theses,and papers presented at conferences.Statistical analyses were performed using Revman 5.3 software.RESULTS Seven non-randomized controlled trials and one randomized controlled trial met the inclusion criteria.In total,1382 patients(1511 polyps)were included in the study,including 722 who received UEMR and 789 who received EMR.In the UEMR and EMR groups,the en bloc resection rates were 85.87%and 73.89%,respectively,with a relative risk(RR)value of 1.14(95%confidence interval[CI]:1.01-1.30;P<0.05).In the sub-group analysis,the en bloc resection rate showed no statistically significant difference between the EMR and UEMR groups for polyps less than 20 mm in diameter.However,a statistically significant difference was found between the EMR and UEMR groups for polyps equal to or greater than 20 mm in diameter.The post-endoscopic resection recurrence rates at 3-6 mo of the UEMR and EMR groups were 3.26%and 15.17%,respectively,with an RR value of 0.27(95%CI:0.09-0.83;P<0.05).The post-endoscopic resection recurrence rates of UEMR and EMR at 12 mo were 6.25%and 14.40%,respectively,with an RR value of 0.43(95%CI:0.20-0.92;P<0.05).Additionally,the incidence of adverse events was 8.17%and 6.21%,respectively,with an RR value of 1.07(95%CI:0.50-2.30;P>0.05).CONCLUSION UEMR is an effective technique for colorectal polyps and appears to have some advantages over EMR,particularly with regard to some treatment outcomes.展开更多
Endoscopic mucosal resection （EMR） is a technique used to locally excise lesions confined to the mucosa. Its main role is the treatment of advanced dysplasia and early gastrointestinal cancers. EMR was originally de...Endoscopic mucosal resection （EMR） is a technique used to locally excise lesions confined to the mucosa. Its main role is the treatment of advanced dysplasia and early gastrointestinal cancers. EMR was originally described as a therapy for early gastric cancer. Recently its use has expanded as a therapeutic option for ampullary masses, colorectal cancer, and large colorectal polyps. In the Western world, the predominant indication for EMR in the upper gastrointestinal tract is the staging and treatment of advance dysplasia and early neoplasia in Barrett＇s esophagus. This review will describe the basis, indications, techniques, and complications of EMR, and its role in the management of Barrett＇s esophagus.展开更多
BACKGROUND The optimal method to remove sessile colorectal lesions sized 10-20 mm remains uncertain.Piecemeal and incomplete resection are major limitations in current practice,such as endoscopic mucosal resection(EMR...BACKGROUND The optimal method to remove sessile colorectal lesions sized 10-20 mm remains uncertain.Piecemeal and incomplete resection are major limitations in current practice,such as endoscopic mucosal resection(EMR)and cold or hot snare polypectomy.Recently,EMR with circumferential precutting(EMR-P)has emerged as an effective technique,but the quality of current evidence in comparative studies of conventional EMR(CEMR)and EMR-P is limited.AIM To investigate whether EMR-P is superior to CEMR in removing sessile colorectal polyps.METHODS This multicenter randomized controlled trial involved seven medical institutions in China.Patients with colorectal polyps sized 10-20 mm were enrolled and randomly assigned to undergo EMR-P or CEMR.EMR-P was performed following submucosal injection,and a circumferential mucosa incision(precutting)was conducted using a snare tip.Primary outcomes included a comparison of the rates of en bloc and R0 resection,defined as one-piece resection and one-piece resection with histologically assessed clear margins,respectively.RESULTS A total of 110 patients in the EMR-P group and 110 patients in the CEMR group were finally evaluated.In the per-protocol analysis,the proportion of en bloc resections was 94.3%[95%confidence interval(CI):88.2%-97.4%]in the EMR-P group and 86%(95%CI:78.2%-91.3%)in the CEMR group(P=0.041),while subgroup analysis showed that for lesions>15 mm,EMR-P also resulted in a higher en bloc resection rate(92.0%vs 58.8%P=0.029).The proportion of R0 resections was 81.1%(95%CI:72.6%-87.4%)in the EMR-P group and 76.6%(95%CI:68.8%-84.4%)in the CEMR group(P=0.521).The EMR-P group showed a longer median procedure time(6.4 vs 3.0 min;P<0.001).No significant difference was found in the proportion of patients with adverse events(EMR-P:9.1%;CEMR:6.4%;P=0.449).CONCLUSION In this study,EMR-P served as an alternative to CEMR for removing nonpedunculated colorectal polyps sized 10-20 mm,particularly polyps>15 mm in diameter,with higher R0 and en bloc resection rates and without increasing adverse events.However,EMR-P required a relatively longer procedure time than CEMR.Considering its potential benefits for en bloc and R0 resection,EMR-P may be a promising technique in colorectal polyp resection.展开更多
We reviewed a study that reported a comparative analysis of the effects of endoscopic mucosal resection(EMR)precutting and conventional EMR for removing non-pedunculated,10-20 mm sized colorectal polyps.We identified ...We reviewed a study that reported a comparative analysis of the effects of endoscopic mucosal resection(EMR)precutting and conventional EMR for removing non-pedunculated,10-20 mm sized colorectal polyps.We identified some statistical deficiencies in this study.In addition,we believe that the differences between the treatments failed to achieve significance,and therefore,further analysis is required.展开更多
AIM: To compare the efficacy and safety of endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for the treatment of colorectal tumors.
Endoscopic mucosal resection （EMR） has been established as one of the treatment options for early gastric cancer （EGC）. However, there are many uncertain areas such as indications of EIR, best treatment methods, m...Endoscopic mucosal resection （EMR） has been established as one of the treatment options for early gastric cancer （EGC）. However, there are many uncertain areas such as indications of EIR, best treatment methods, management of complications and follow-up methods after the procedure. Host studies on this topic have been carried out by researchers in Japan. In Korea, gastric cancer is the most common malignant disease, and the second leading cause of cancer death. In these days, EIR for EGC is widely performed in many centers in Korea. In this review, we will provide an overview of the bechniques and outcomes of EIR in Korea.展开更多
AIM: To investigate the effectiveness of endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) in treating superficial esophageal cancer (SEC).
AIM： To clarify the risk factors for bleeding after endoscopic mucosal resection （EMR）. METHODS： A total of 297 consecutive patients who underwent EMR were enrolled. Some of the patients had multiple lesions. Blee...AIM： To clarify the risk factors for bleeding after endoscopic mucosal resection （EMR）. METHODS： A total of 297 consecutive patients who underwent EMR were enrolled. Some of the patients had multiple lesions. Bleeding requiring endoscopic treatment was defined as bleeding after EMR. Odds ratios （OR） with 95% confidence intervals （CI）, calculated by logistic regression with multivariate adjustments for covariates, were the measures of association. RESULTS： Of the 297 patients, 57 （19.2%） patients with bleeding after EMR were confirmed. With multivariate adjustment, the cutting method of EMR, diameter, and endoscopic pattern of the tumor were associated with the risk of bleeding after EMR. The multivariate-adjusted OR for bleeding after EMR using endoscopic aspiration mucosectomy was 3.07 （95%CI, 1.59-5.92） compared with strip biopsy. The multiple-adjusted OR for bleeding after EMR for the highest quartile （16-50 mm） of tumor diameter was 5.63 （95%CI, 1.84-17.23） compared with that for the lowest （4-7 mm）. The multiple-adjusted OR for bleeding after EMR for depressed type of tumor was 4.21 （95%CI, 1.75-10.10） compared with elevated type. CONCLUSION： It is important to take tumor charactedstics （tumor size and endoscopic pattern） and cutting method of EMR into consideration in predicting bleeding after EMR.展开更多
AIM: To evaluate the safety and outcomes of endoscopic piecemeal mucosal resection (EPMR) for large sessile colorectal polyps. METHODS: The patients enrolled in this study were 47 patients with 50 large sessile polyps...AIM: To evaluate the safety and outcomes of endoscopic piecemeal mucosal resection (EPMR) for large sessile colorectal polyps. METHODS: The patients enrolled in this study were 47 patients with 50 large sessile polyps (diameter, 2 cm or greater) who underwent EPMR using a submucosal saline injection technique between December 2002 and October 2005. All medical records, including characteristics of the patients and polyps, complications, and recurrences, were retrospectively reviewed. The first follow-up endoscopic examination was performed at 3-6 mo after initial endoscopic resection, and the second at 12 mo postEPMR. Subsequent surveillance colonoscopic examinations were individualized, taking risk factors into account. RESULTS: The patients were 23 men and 24 women,with a mean age of 60 years. Mean polyp size was 30.1 mm. Of 50 polyps identified, 34 (68%) were benign and 16 (32%) were malignant. There were 6 (12%) cases with EPMR-related bleeding: 5 intra-procedural and 1 early post-procedural bleeding. All bleeding episodes were managed by endoscopic clipping or argon beam coagulation. There were no perforations. Recurrence was identified in 5 cases (12.2%): 4 local recurrences detected at 3 mo post-EPMR and 1 local recurrence detected at 14 mo post-EPMR. The recurrence rate after EPMR was 3.1% for benign polyps and 33.3% for malignant polyps (P < 0.05). Median follow-up time was 37 mo. CONCLUSION: EPMR is safe, but should be applied carefully in malignant polyps. Close follow-up endoscopic examinations are necessary for early detection of recurrence.展开更多
Heterotopic pancreas is a congenital anomaly characterized by ectopic pancreatic tissue.Treatment of heterotopic pancreas may include expectant observation,endoscopic resection or surgery.The aim of this report was to...Heterotopic pancreas is a congenital anomaly characterized by ectopic pancreatic tissue.Treatment of heterotopic pancreas may include expectant observation,endoscopic resection or surgery.The aim of this report was to describe the technique of ligation-assisted endoscopic mucosal resection(EMR) for resection of heterotopic pancreas of the stomach.Two patients(both female,mean age 32 years) were referred for management of gastric subepithelial tumors.Endoscopic ultrasound in both disclosed small hypoechoic masses in the mucosa and submucosa.Band ligation-assisted EMR was performed in both cases without complications.Pathology from the resected tumors revealed heterotopic pancreas arising from the submucosa.Margins were free of pancreatic tissue.Ligation-assisted EMR is technically feasible and may be considered for the endoscopic management of heterotopic pancreas.展开更多
BACKGROUND Endoscopic submucosal dissection(ESD)has shown to be effective in management of colorectal neoplasm in the Asian countries,while its implementation in Western countries where endoscopic mucosal resection(EM...BACKGROUND Endoscopic submucosal dissection(ESD)has shown to be effective in management of colorectal neoplasm in the Asian countries,while its implementation in Western countries where endoscopic mucosal resection(EMR)is preferred is still debatable.AIM To compare the surgical,histological,and oncological outcomes between ESD and EMR in the treatment of colorectal polyps,with subgroup analysis comparing the efficacy of ESD and EMR between Japan and the rest of the world.METHODS Embase and Medline databases were searched from inception to October 2020 in accordance with PRISMA guidelines for studies comparing en bloc,complete resection,margin involvement,resection time,need for additional surgery,complications,and recurrence rate of ESD with EMR.RESULTS Of 281344 colorectal polyps from 21 studies were included.When compared to EMR,the pooled analysis revealed ESD was associated with higher en bloc and complete resection rate,and lower lateral margin involvement and recurrence.ESD led to increased procedural time,need for additional surgery,and perforation risk.No significant difference in bleeding risk was found between the two groups.Meta-regression analysis suggested only right colonic polyps correlated with an increased perforation risk in ESD.Confounders including polyp size and invasion depth did not significantly influence the en bloc and complete resection rate,bleeding risk and recurrence.In subgroup analysis,Japan performed better than the rest of the world in both ESD and EMR with perforation risk of 4%and 0.0002%,respectively,as compared to perforation risk of 8%and 1%,respectively,in reports coming from rest of the world.CONCLUSION ESD resulted in better resection outcomes and lower recurrence compared to EMR.With appropriate training,ESD is preferred over EMR as the first-line therapy for resection of colorectal polyps,without restricting to lesions greater than 20 mm and those with high suspicion of submucosal invasion.展开更多
文摘BACKGROUND Underwater endoscopic mucosal resection(UEMR)has been shown to be a good treatment option for the management of nonpedunculated polyps≥10 mm since its introduction.However,there is a paucity of randomized controlled trials(RCTs)in Asia.AIM To compare the efficacy and safety of UEMR with those of conventional EMR(CEMR)in treating nonpedunculated colorectal lesions.METHODS We carried out this RCT at a tertiary hospital from October 2022 to July 2024.Patients with nonpedunculated colorectal neoplasms ranging from 10 mm to 30 mm in size were randomly assigned to either the UEMR or CEMR group.The primary outcome was the curative resection(R0)rate.The secondary outcomes included en bloc resection,procedure time,adverse events,and the number of clips used for defect closure.RESULTS A total of 260 patients with 260 lesions(130 in each UEMR and CEMR group)were recruited.The median age was 58(27-85)years,the male/female ratio was 1.74,and the median lesion size was 20(10-30 mm)mm.Compared with CEMR,UEMR was associated with a significantly greater curative resection(R0)rate(98.4%vs 90.3%;P=0.007),greater en bloc resection rate(100%vs 94.6%;P=0.014),shorter procedure time(65 vs 185 seconds;P<0.001),lower rate of bleeding complications(1.5%vs 10%;P=0.003),and fewer clips used(2 vs 3;P<0.001).No perforations were observed in either group.CONCLUSION Compared with CEMR,UEMR has a higher R0 rate,greater en bloc resection rate,shorter procedure time,fewer bleeding complications,and clips used in the management of nonpedunculated colorectal neoplasms.
基金Clinical Study on Endoscopic Resection of Colorectal Submucosal Tumors Using Underwater Combined with Metal Clip-Assisted Snare,China(Grant No.2441ZF271)。
文摘Objective:To explore the clinical feasibility and safety of modified endoscopic mucosal resection for rectal neuroendocrine tumors(R-NETs).Methods:Seventy cases of R-NETs treated with endoscopic mucosal resection in our hospital between April 2022 and March 2024 were selected and divided into the control group and the observation group using the mean score method,each with 35 cases.In the control group,traditional endoscopic mucosal resection(EMR)was performed,and in the observation group,modified EMR(endoscopic mucosal resection with ligation apparatus[EMR-L])was performed.The operation time,hospitalization time,operation cost,and related complication rate of the two groups of patients were compared.Results:The operation time(20.36±1.46 min)and hospital stay(3.37±0.51 d)of patients in the observation group were shorter than those of the control group(31.44±2.65 min and 4.73±0.49 d).The cost of the operation in the observation group(7,695.85±1,521.42 yuan)was lower than that of the control group(8,418.62±1219.30 yuan),and the difference was statistically significant(P<0.05).The total incidence of postoperative related complications in the observation group was observed to be 11.42%,which was significantly lower than that of 31.42%in the control group,and the difference was statistically significant(P<0.05).Conclusion:The application of modified EMR in R-NETs is remarkable,which can not only effectively shorten the operation time and hospital stay,but also further reduce the risk of related complications,and indirectly save a large amount of hospital costs;thus,it is recommended to be promoted and applied clinically.
基金Supported by Ministry of Science and Higher Education of the Russian Federation,No.FGMF-2025-0003.
文摘Colorectal cancer remains a major health concern,with colorectal polyps as key precursors.Endoscopic mucosal resection(EMR)is a common treatment,but recurrence rates remain high.Traditional surveillance strategies rely on polyp characteristics and completeness of the resection potentially missing key risk factors.Machine learning(ML)offers a transformative approach by integrating patient-specific data to refine risk stratification.Recent studies highlight ML models,such as Extreme Gradient Boosting,which outperform conventional methods in predicting polyp recurrence within one-year post-EMR.These models incorporate factors like age,smoking status,family history,and pathology,optimizing follow-up recommendations and minimizing unnecessary procedures.Artificial intelligence(AI)-driven tools and web-based calculators enhance clinical workflow by providing real-time,personalized risk assessments.However,challenges remain in external validation,model interpretability,and clinical integration.Future surveillance strategies should combine expert judgment with AI insights to optimize patient outcomes.As gastroenterology embraces AI,MLdriven surveillance represents a paradigm shift,advancing precision medicine in colorectal polyp management.This editorial explores AI’s role in transforming post-EMR follow-up,addressing benefits,limitations,and future directions.
基金Supported by the Wuhu Municipal Science and Technology Bureau Project,No.2024kj072.
文摘In 2025,Shi et al constructed a model utilizing machine learning techniques to predict the one-year recurrence of colorectal polyps following endoscopic mucosal resection,showing excellent discriminatory performance with an area under the curve exceeding 0.90.However,limitations exist regarding its narrow temporal scope,potential overestimation due to feature collinearity and imputation opacity,and limited generalizability due to single-center derivation and validation.Moreover,no clear clinical implementation strategy was outlined.Prospective multicenter validation and integration of endoscopist variability,longitudinal outcome data,and deployment mechanisms are warranted to ensure broader applicability and clinical utility.
文摘BACKGROUND Although substantial evidence supports the advantages of cold snare polypectomy(CSP)in terms of polypectomy efficacy and reduced postoperative adverse events,few studies have examined the cost differences between CSP and traditional endoscopic mucosal resection(EMR)for the treatment of intestinal polyps.AIM To compare the efficacy-cost of EMR and CSP in the treatment of intestinal polyps.METHODS A total of 100 patients with intestinal polyps were included in the retrospective data of our hospital from April 2022 to May 2023.According to the treatment methods,they were divided into EMR(n=46)group and CSP(n=54)group.The baseline data of the two groups were balanced by 1:1 propensity score matching(PSM),and the cost-effectiveness analysis was performed on the two groups after matching.The recurrence rate of the two groups of patients was followed up for 1 year,and they were divided into recurrence group and non-recurrence group according to whether they recurred.Multivariate logistic regression analysis was used to screen out the influencing factors affecting the recurrence of intestinal polyps after endoscopic resection.RESULTS Significant disparities were observed in the number of polyps and smoking background between the two groups before PSM(P<0.05).Following PSM,the number of polyps and smoking history were well balanced between the EMR and CSP groups.The direct cost incurred by the CSP group was markedly higher than that incurred by the EMR group.Concurrently,the cost-effectiveness ratio in the CSP group was substantially reduced when juxtaposed with that in the EMR group(P<0.05).Upon completion of the 1-year follow-up,the rate of recurrence after endoscopic intestinal polypectomy was 38.00%.Multivariate methods revealed that age≥60 years,male sex,number of polyps≥3,and pathological type of adenoma were risk factors for recurrence after endoscopic intestinal polypectomy(all P<0.05).CONCLUSION CSP was more cost-effective for the treatment of intestinal polyps.An age≥60 years,male sex,having a number of polyps≥3,and pathological type of adenoma are independent influencing factors for recurrence.
文摘The machine learning model developed by Shi et al for predicting colorectal polyp recurrence after endoscopic mucosal resection represents a significant advancement in the field of clinical gastroenterology.By integrating patient-specific factors,such as age,smoking history,and Helicobacter pylori infection,the eXtreme Gradient Boosting algorithm enables precise personalised colonoscopy follow-up planning and risk assessment.This predictive tool offers substantial benefits by optimising surveillance intervals and directing healthcare resources more efficiently toward high-risk individuals.However,real-world implementation requires consideration of the generalisability of our findings across diverse patient populations and clinician training backgrounds.
文摘BACKGROUND In recent years,endoscopic anti-reflux mucosal resection(ARMS)has demonstrated benefits,including good efficacy,ease of operation,low cost,and fewer complications;however,it is still in the exploratory stage.AIM To evaluate the clinical efficacy of ARMS in patients with gastroesophageal reflux disease(GERD)and its effects on the gut microbiota.METHODS This single-center,retrospective,self-controlled study included 80 patients with GERD.All patients underwent endoscopic ARMS and were followed for at least 3 months after surgery.The primary outcome measures were changes in the gut microbiota before and after treatment and clinical efficacy.RESULTS After surgery,the counts of Escherichia coli and Staphylococcus aureus were significantly lower than those before surgery(P<0.05),whereas the counts of Bifidobacterium and Lactobacillus were significantly higher than those before surgery(P<0.05).Symptoms,such as reflux and heartburn,were markedly relieved postoperatively.The average Gerd Q score prior to surgery was 11.32±1.26 points,which decreased to 5.89±0.52 points 3 months after surgery.All patients used proton pump inhibitors before surgery,and the proportion of patients using proton pump inhibitors declined significantly postoperatively.Sixteen patients(20.0%)experienced surgery-related adverse reactions within 2 weeks to 1 month post-surgery.The incidence rates of postoperative esophageal stricture and delayed bleeding were 15.0%and 5.0%,respectively.CONCLUSION Endoscopic ARMS can effectively alleviate reflux symptoms,maintain gut microbiota balance,and improve gastrointestinal function in patients with GERD.
基金Clinical Study on Endoscopic Resection of Colorectal Submucosal Tumors Using Underwater Combined with Metal Clip-Assisted Snare,China(Grant No.2441ZF271)。
文摘Objective:To analyze the application value of modified endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)in rectal neuroendocrine tumors,with a view to providing new clinical options for the early diagnosis and treatment of patients with such tumors,and thus improving their prognosis.Methods:Seventy-two patients with rectal neuroendocrine tumors who underwent surgical treatment in a hospital between October 2023 and September 2024 were selected and divided into a control group and an observation group using the mean score method,each with 36 cases.In the control group,traditional foreign body forceps combined with laparoscopic resection were performed,and in the observation group,modified EMR and ESD were performed as needed.The mass resection rate,histologically intact resection rate,postoperative serum vascular endothelial growth factors(VEGFA,VEGFB,VEGFC levels)in the postoperative period of 7d,and indicators of the rate of related complications of the two groups of patients were compared.Results:The mass resection rate of 91.67%and histological complete resection rate of 94.44%in the observation group were significantly higher than those of 72.22%and 66.67%in the control group;the VEGFA,VEGFB,and VEGFC levels of the observation group were 82.08±7.94 ng/ml,168.89±16.53 ng/ml,and 121.07±10.75 ng/ml,respectively,in the postoperative period of 7 d after surgery;the levels were significantly higher than those of the control group:68.39±6.82 ng/ml,141.06±14.12 ng/ml,and 98.45±9.87 ng/ml,respectively,and the difference was statistically significant(P<0.05);the patients in the observation group had a lower rate of surgical complications than those in the control group(2.78%vs 8.33%),the difference was not statistically significant(P>0.05).Conclusion:Modified EMR and ESD in rectal neuroendocrine tumors are effective,not only can it effectively improve the rate of mass resection and histological integrity of the resection rate,but it can also further improve the level of serum vascular endothelial growth factor(VEGFA,VEGFB,VEGFC);thus,it is recommended to be promoted for use in clinical practice.
文摘BACKGROUND Duodenal Brunner's gland hyperplasia(BGH)is a therapeutic target when complications such as bleeding or gastrointestinal obstruction occur or when malignancy cannot be ruled out.Herein,we present a case of large BGH treated with endoscopic mucosal resection(EMR).CASE SUMMARY An 83-year-old woman presented at our hospital with dizziness.Blood tests revealed severe anemia,esophagogastroduodenoscopy showed a 6.5 cm lesion protruding from the anterior wall of the duodenal bulb,and biopsy revealed the presence of glandular epithelium.Endoscopic ultrasonography(EUS)demonstr-ated relatively high echogenicity with a cystic component.The muscularis propria was slightly elevated at the base of the lesion.EMR was performed without complications.The formalin-fixed lesion size was 6 cm×3.5 cm×3 cm,showing nodular proliferation of non-dysplastic Brunner's glands compartmentalized by fibrous septa,confirming the diagnosis of BGH.Reports of EMR or hot snare polypectomy are rare for duodenal BGH>6 cm.In this case,the choice of EMR was made by obtaining information on the base of the lesion as well as on the internal characteristics through EUS.CONCLUSION Large duodenal lesions with good endoscopic maneuverability and no evident muscular layer involvement on EUS may be resectable via EMR.
文摘BACKGROUND Underwater endoscopic mucosal resection(UEMR)of colorectal lesions is emerging as an alternative method to conventional endoscopic mucosal resection(EMR);however,it is still controversial whether there is a difference in the effectiveness between UEMR and EMR.AIM To evaluate the effectiveness and safety of UEMR in the treatment of colorectal polyps.METHODS Clinical studies comparing the effectiveness or safety of UEMR in the treatment of colorectal polyps were searched in medical databases,including Pub Med,Embase,Cochrane Library,CNKI,and Wanfang Data,monographs,theses,and papers presented at conferences.Statistical analyses were performed using Revman 5.3 software.RESULTS Seven non-randomized controlled trials and one randomized controlled trial met the inclusion criteria.In total,1382 patients(1511 polyps)were included in the study,including 722 who received UEMR and 789 who received EMR.In the UEMR and EMR groups,the en bloc resection rates were 85.87%and 73.89%,respectively,with a relative risk(RR)value of 1.14(95%confidence interval[CI]:1.01-1.30;P<0.05).In the sub-group analysis,the en bloc resection rate showed no statistically significant difference between the EMR and UEMR groups for polyps less than 20 mm in diameter.However,a statistically significant difference was found between the EMR and UEMR groups for polyps equal to or greater than 20 mm in diameter.The post-endoscopic resection recurrence rates at 3-6 mo of the UEMR and EMR groups were 3.26%and 15.17%,respectively,with an RR value of 0.27(95%CI:0.09-0.83;P<0.05).The post-endoscopic resection recurrence rates of UEMR and EMR at 12 mo were 6.25%and 14.40%,respectively,with an RR value of 0.43(95%CI:0.20-0.92;P<0.05).Additionally,the incidence of adverse events was 8.17%and 6.21%,respectively,with an RR value of 1.07(95%CI:0.50-2.30;P>0.05).CONCLUSION UEMR is an effective technique for colorectal polyps and appears to have some advantages over EMR,particularly with regard to some treatment outcomes.
文摘Endoscopic mucosal resection （EMR） is a technique used to locally excise lesions confined to the mucosa. Its main role is the treatment of advanced dysplasia and early gastrointestinal cancers. EMR was originally described as a therapy for early gastric cancer. Recently its use has expanded as a therapeutic option for ampullary masses, colorectal cancer, and large colorectal polyps. In the Western world, the predominant indication for EMR in the upper gastrointestinal tract is the staging and treatment of advance dysplasia and early neoplasia in Barrett＇s esophagus. This review will describe the basis, indications, techniques, and complications of EMR, and its role in the management of Barrett＇s esophagus.
基金the Institutional Review Board of First Affiliated Hospital,School of Medicine,Zhejiang University(No.20191477)Ningbo First Hospital,Zhejiang(No.2020-R013)and other participating institutions.
文摘BACKGROUND The optimal method to remove sessile colorectal lesions sized 10-20 mm remains uncertain.Piecemeal and incomplete resection are major limitations in current practice,such as endoscopic mucosal resection(EMR)and cold or hot snare polypectomy.Recently,EMR with circumferential precutting(EMR-P)has emerged as an effective technique,but the quality of current evidence in comparative studies of conventional EMR(CEMR)and EMR-P is limited.AIM To investigate whether EMR-P is superior to CEMR in removing sessile colorectal polyps.METHODS This multicenter randomized controlled trial involved seven medical institutions in China.Patients with colorectal polyps sized 10-20 mm were enrolled and randomly assigned to undergo EMR-P or CEMR.EMR-P was performed following submucosal injection,and a circumferential mucosa incision(precutting)was conducted using a snare tip.Primary outcomes included a comparison of the rates of en bloc and R0 resection,defined as one-piece resection and one-piece resection with histologically assessed clear margins,respectively.RESULTS A total of 110 patients in the EMR-P group and 110 patients in the CEMR group were finally evaluated.In the per-protocol analysis,the proportion of en bloc resections was 94.3%[95%confidence interval(CI):88.2%-97.4%]in the EMR-P group and 86%(95%CI:78.2%-91.3%)in the CEMR group(P=0.041),while subgroup analysis showed that for lesions>15 mm,EMR-P also resulted in a higher en bloc resection rate(92.0%vs 58.8%P=0.029).The proportion of R0 resections was 81.1%(95%CI:72.6%-87.4%)in the EMR-P group and 76.6%(95%CI:68.8%-84.4%)in the CEMR group(P=0.521).The EMR-P group showed a longer median procedure time(6.4 vs 3.0 min;P<0.001).No significant difference was found in the proportion of patients with adverse events(EMR-P:9.1%;CEMR:6.4%;P=0.449).CONCLUSION In this study,EMR-P served as an alternative to CEMR for removing nonpedunculated colorectal polyps sized 10-20 mm,particularly polyps>15 mm in diameter,with higher R0 and en bloc resection rates and without increasing adverse events.However,EMR-P required a relatively longer procedure time than CEMR.Considering its potential benefits for en bloc and R0 resection,EMR-P may be a promising technique in colorectal polyp resection.
文摘We reviewed a study that reported a comparative analysis of the effects of endoscopic mucosal resection(EMR)precutting and conventional EMR for removing non-pedunculated,10-20 mm sized colorectal polyps.We identified some statistical deficiencies in this study.In addition,we believe that the differences between the treatments failed to achieve significance,and therefore,further analysis is required.
文摘AIM: To compare the efficacy and safety of endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for the treatment of colorectal tumors.
文摘Endoscopic mucosal resection （EMR） has been established as one of the treatment options for early gastric cancer （EGC）. However, there are many uncertain areas such as indications of EIR, best treatment methods, management of complications and follow-up methods after the procedure. Host studies on this topic have been carried out by researchers in Japan. In Korea, gastric cancer is the most common malignant disease, and the second leading cause of cancer death. In these days, EIR for EGC is widely performed in many centers in Korea. In this review, we will provide an overview of the bechniques and outcomes of EIR in Korea.
文摘AIM: To investigate the effectiveness of endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) in treating superficial esophageal cancer (SEC).
文摘AIM： To clarify the risk factors for bleeding after endoscopic mucosal resection （EMR）. METHODS： A total of 297 consecutive patients who underwent EMR were enrolled. Some of the patients had multiple lesions. Bleeding requiring endoscopic treatment was defined as bleeding after EMR. Odds ratios （OR） with 95% confidence intervals （CI）, calculated by logistic regression with multivariate adjustments for covariates, were the measures of association. RESULTS： Of the 297 patients, 57 （19.2%） patients with bleeding after EMR were confirmed. With multivariate adjustment, the cutting method of EMR, diameter, and endoscopic pattern of the tumor were associated with the risk of bleeding after EMR. The multivariate-adjusted OR for bleeding after EMR using endoscopic aspiration mucosectomy was 3.07 （95%CI, 1.59-5.92） compared with strip biopsy. The multiple-adjusted OR for bleeding after EMR for the highest quartile （16-50 mm） of tumor diameter was 5.63 （95%CI, 1.84-17.23） compared with that for the lowest （4-7 mm）. The multiple-adjusted OR for bleeding after EMR for depressed type of tumor was 4.21 （95%CI, 1.75-10.10） compared with elevated type. CONCLUSION： It is important to take tumor charactedstics （tumor size and endoscopic pattern） and cutting method of EMR into consideration in predicting bleeding after EMR.
基金Supported by Grants from the National Cancer Center of Korea, NCC-0710362 and NCC-0910520
文摘AIM: To evaluate the safety and outcomes of endoscopic piecemeal mucosal resection (EPMR) for large sessile colorectal polyps. METHODS: The patients enrolled in this study were 47 patients with 50 large sessile polyps (diameter, 2 cm or greater) who underwent EPMR using a submucosal saline injection technique between December 2002 and October 2005. All medical records, including characteristics of the patients and polyps, complications, and recurrences, were retrospectively reviewed. The first follow-up endoscopic examination was performed at 3-6 mo after initial endoscopic resection, and the second at 12 mo postEPMR. Subsequent surveillance colonoscopic examinations were individualized, taking risk factors into account. RESULTS: The patients were 23 men and 24 women,with a mean age of 60 years. Mean polyp size was 30.1 mm. Of 50 polyps identified, 34 (68%) were benign and 16 (32%) were malignant. There were 6 (12%) cases with EPMR-related bleeding: 5 intra-procedural and 1 early post-procedural bleeding. All bleeding episodes were managed by endoscopic clipping or argon beam coagulation. There were no perforations. Recurrence was identified in 5 cases (12.2%): 4 local recurrences detected at 3 mo post-EPMR and 1 local recurrence detected at 14 mo post-EPMR. The recurrence rate after EPMR was 3.1% for benign polyps and 33.3% for malignant polyps (P < 0.05). Median follow-up time was 37 mo. CONCLUSION: EPMR is safe, but should be applied carefully in malignant polyps. Close follow-up endoscopic examinations are necessary for early detection of recurrence.
文摘Heterotopic pancreas is a congenital anomaly characterized by ectopic pancreatic tissue.Treatment of heterotopic pancreas may include expectant observation,endoscopic resection or surgery.The aim of this report was to describe the technique of ligation-assisted endoscopic mucosal resection(EMR) for resection of heterotopic pancreas of the stomach.Two patients(both female,mean age 32 years) were referred for management of gastric subepithelial tumors.Endoscopic ultrasound in both disclosed small hypoechoic masses in the mucosa and submucosa.Band ligation-assisted EMR was performed in both cases without complications.Pathology from the resected tumors revealed heterotopic pancreas arising from the submucosa.Margins were free of pancreatic tissue.Ligation-assisted EMR is technically feasible and may be considered for the endoscopic management of heterotopic pancreas.
文摘BACKGROUND Endoscopic submucosal dissection(ESD)has shown to be effective in management of colorectal neoplasm in the Asian countries,while its implementation in Western countries where endoscopic mucosal resection(EMR)is preferred is still debatable.AIM To compare the surgical,histological,and oncological outcomes between ESD and EMR in the treatment of colorectal polyps,with subgroup analysis comparing the efficacy of ESD and EMR between Japan and the rest of the world.METHODS Embase and Medline databases were searched from inception to October 2020 in accordance with PRISMA guidelines for studies comparing en bloc,complete resection,margin involvement,resection time,need for additional surgery,complications,and recurrence rate of ESD with EMR.RESULTS Of 281344 colorectal polyps from 21 studies were included.When compared to EMR,the pooled analysis revealed ESD was associated with higher en bloc and complete resection rate,and lower lateral margin involvement and recurrence.ESD led to increased procedural time,need for additional surgery,and perforation risk.No significant difference in bleeding risk was found between the two groups.Meta-regression analysis suggested only right colonic polyps correlated with an increased perforation risk in ESD.Confounders including polyp size and invasion depth did not significantly influence the en bloc and complete resection rate,bleeding risk and recurrence.In subgroup analysis,Japan performed better than the rest of the world in both ESD and EMR with perforation risk of 4%and 0.0002%,respectively,as compared to perforation risk of 8%and 1%,respectively,in reports coming from rest of the world.CONCLUSION ESD resulted in better resection outcomes and lower recurrence compared to EMR.With appropriate training,ESD is preferred over EMR as the first-line therapy for resection of colorectal polyps,without restricting to lesions greater than 20 mm and those with high suspicion of submucosal invasion.
