The endoscopic resection of gastrointestinal tract lesions embraces different types of techniques, ranging from conventional polypectomy/endoscopic mucosal resection (EMR) to the field of third-space endoscopy, including endoscopic submucosal dissection (ESD), full-thickness resection and peroral endoscopic myotomy (POEM). Parallelly, the advent of underwater techniques has served as an add-on for both basic and advanced procedures, since its first report in 2012. We aimed to provide a comprehensive update on the state of the art about the feasibility of underwater basic and advanced techniques for GI endoscopy. Underwater EMR (U-EMR) has proved effective and safe in treating > 10 mm sessile or flat or all-size recurrent colonic lesions. Conversely, although data show good effectiveness and safety for <10 mm lesions, it is preferred when high-grade dysplasia is suspected, favouring cold snare polypectomy for all other cases. Moreover, promising data are emerging regarding the feasibility of U-ESD for difficult-to-resect colonic lesions. U-EMR represents a standard of care for treating < 25 mm superficial non-ampullary duodenal epithelial tumours. Data regarding oesophageal, gastric and ampullary lesions remains limited to small cohorts. Finally, using water immersion for POEM has shown a reduction in procedure time compared to the CO2insufflation technique for vessel coagulation, albeit in a single-centre experience. Based on these results, U-EMR has become a standard for treating intermediate-size colonic and non-ampullary duodenal lesions, as highlighted also in the European Society of Gastrointestinal Endoscopy guidelines. Promising results have been shown in third-space endoscopy studies, even though further prospective studies are awaited to standardise the technique for both ESD and POEM.
胃肠道病变的内镜下切除技术种类多样，从传统的息肉切除术/内镜下黏膜切除术（EMR）到第三空间内镜领域，包括内镜黏膜下剥离术（ESD）、全层切除术以及经口内镜下肌切开术（POEM）。与此同时，自2012年首次报道以来，水下技术的出现为基础和高级内镜操作提供了补充。本文旨在全面更新关于水下基础与高级内镜技术在胃肠道内镜中应用可行性的最新进展。水下EMR（U-EMR）已被证明在治疗大于10毫米的无蒂或平坦型或任何大小的复发性结肠病变方面有效且安全。相反，尽管数据显示对于小于10毫米的病变具有良好的有效性和安全性，但更适用于高度异型增生可疑的情况，其他情况则更倾向于选择冷圈套息肉切除术。此外，关于U-ESD用于难以切除的结肠病变的可行性，已有令人鼓舞的数据出现。U-EMR已成为治疗小于25毫米的表浅非壶腹部十二指肠上皮肿瘤的标准方法。关于食管、胃和壶腹部病变的数据仍局限于小规模队列研究。最后，与二氧化碳注气技术相比，在POEM中使用水浸技术进行血管凝固可缩短手术时间，尽管这仅为单中心经验。基于这些结果，U-EMR已成为治疗中等大小结肠和非壶腹部十二指肠病变的标准方法，欧洲胃肠道内镜学会指南也强调了这一点。第三空间内镜研究已显示出有希望的结果，尽管仍需进一步的前瞻性研究来标准化ESD和POEM的技术应用。
Underwater Techniques in Gastrointestinal Endoscopy: Diving into the Depths
肿瘤(癌症)患者之家