AVALIAÇÃO DAS RESSECÇÕES DE LESÕES NEOPLASICAS DO CÓLON PELA TÉCNICA MUCOSECTOMIA UNDERWATER COLORRETAIS

Resection of colorectal lesions such as adenomas and serrated lesions is well established for the prevention of colorectal carcinoma. Underwater endoscopic mucosal resection (UEMR), performed without submucosal injection, has been described as an alternative technique. This study aims to evaluate the feasibility, safety, and efficacy of UEMR through a prospective observational study of a non-consecutive case series conducted at a single tertiary care center between January and July 2019. Patients were referred for endoscopic resection of serrated lesions or colorectal adenomas detected during previous colonoscopic examinations. A total of 36 patients underwent UEMR for 51 colorectal lesions. The mean/median lesion size was 16.24/13 mm, and the mean/median resection time was 16.97/9.19 minutes. Histopathological evaluation revealed the following: tubular adenoma (43.1%), tubulovillous adenoma (13.7%), serrated lesions (41.2%) —of which 2 (4%) were traditional serrated adenomas, 6 (11.7%) were sessile serrated polyps, 13 (25.5%) were hyperplastic polyps—and intramucosal adenocarcinoma (2%). Complete resection was achieved in 44 of 51 lesions (86.3%). Monobloc removal occurred in 52.9% of cases, while piecemeal resection was performed in 47.1%. UEMR was endoscopically successful in 96.1% of cases. In 3.9% of cases (2 lesions), the technique was not viable, requiring conversion to conventional mucosectomy. No intestinal perforation or post-polypectomy syndrome was reported. Post-resection bleeding occurred in 6 lesions (11.8%), 5 of which were immediate and 1 delayed, all controlled endoscopically. In conclusion, UEMR proved to be a feasible, safe, and effective technique for the removal of serrated lesions and colorectal adenomas. Further randomized and controlled studies are encouraged to support the widespread adoption of this technique.