Evidence map›Paper›PMID 31628954›Full record

Trial reportGastrointestinal endoscopy2020

Underwater versus conventional endoscopic resection of nondiminutive nonpedunculated colorectal lesions: a prospective randomized controlled trial (with video).

Andrew W Yen, Joseph W Leung, Machelle D Wilson, Felix W Leung

Registry-linked trialOpen access · greenAbstract readComparative StudyRandomized Controlled TrialVideo-Audio Media
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Gastrointestinal endoscopy, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02889679 (Underwater Resection of Non-pedunculated Colorectal Lesions), which is not on this map. Cited by 37 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
37citing papers in PubMed, 6 pooled it
3.8field-weighted citation impact, top 5% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02889679 nacompletednot on this map

Underwater Resection of Non-pedunculated Colorectal Lesions: A Randomized Controlled Trial

TypeinterventionalSponsorVA Northern California Health Care SystemRan2016 to 2018Enrolled600ConditionsColorectal NeoplasmsArmsUnderwater resection, Conventional (gas distended colon) resection, Standard polypectomy
3 · Its place in the literature

Who cites it

37 citing papers in PubMed, 6 syntheses or guidelines pooled it, 68 citations in OpenAlex.

  1. Pooled it
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  11. UnderwaterWorld journal of gastrointestinal surgery · 2025
    Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors at 3 institutions in 1 country.

Andrew W YenSacramento Veterans Affairs Medical Center, VA Northern California Health Care System, Division of Gastroenterology, Mather, California, USA; University of California Davis School of Medicine, Sacramento, California, USA.
Joseph W LeungSacramento Veterans Affairs Medical Center, VA Northern California Health Care System, Division of Gastroenterology, Mather, California, USA; University of California Davis School of Medicine, Sacramento, California, USA.
Machelle D WilsonClinical and Translational Science Center, Department of Public Health Sciences, Division of Biostatistics, University of California Davis, Sacramento, California, USA.
Felix W LeungSepulveda Ambulatory Care Center, VA Greater Los Angeles Healthcare System, Division of Gastroenterology, North Hills, California, USA; David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
University of California, Davis · USVA Greater Los Angeles Healthcare System · USVA Northern California Health Care System · US

Funding

UC Davis Clinical and Translational Science CenterUL1TR001860 · NCATS · UNIVERSITY OF CALIFORNIA AT DAVIS · PI KENYON, NICHOLAS J., LYLES, COURTNEY REES · 2016 to 2025
$47.3M
NCATS NIH HHS UL1 TR001860
6 · The paper itself

Abstract

BACKGROUND AND

aimsIncomplete resection of colorectal neoplasia decreases the efficacy of colonoscopy. Conventional resection (CR) of polyps, performed in a gas-distended colon, is the current standard, but incomplete resection rates of approximately 2% to 30% for nondiminutive (>5 mm), nonpedunculated lesions are reported. Underwater resection (UR) is a novel technique. The aim of this study was to determine the incomplete resection rates of colorectal lesions removed by UR versus CR.

methodsIn a randomized controlled trial, patients with small (6-9 mm) and large (≥10 mm) nonpedunculated lesions were assigned to CR (gas-distended lumen) or UR (water-filled, gas-excluded lumen). Small lesions in both arms were removed with a dedicated cold snare. For CR, large lesions were removed with a hot snare after submucosal injection. For UR, large lesions were removed with a hot snare without submucosal injection. Four-quadrant biopsy samples around the resection sites were used to evaluate for incomplete resection.

resultsFour hundred sixty-two eligible polyps (248 UR vs 214 CR) from 255 patients were removed. Incomplete resection rates for UR and CR were low and did not differ (2% vs 1.9%, P = .91). UR was performed significantly faster for lesions ≥10 mm in size (10-19 mm, 2.9 minutes vs 5.6 minutes, P < .0001); ≥20 mm, 7.3 minutes vs 9.5 minutes, P = .015).

conclusionsLow incomplete resection rates are achievable with UR and CR. UR is effective and safe with the advantage of faster resection and potential cost savings for removal of larger (≥10 mm) lesions by avoiding submucosal injection. As an added approach, UR has potential to improve the cost-effectiveness of colonoscopy by increasing efficiency and reducing cost while maintaining quality. (Clinical trial registration number: NCT02889679.).

Indexed as

Colonic PolypsColorectal NeoplasmsEndoscopic Mucosal ResectionAdultAgedAged, 80 and overColonoscopyFemaleHumansMaleMiddle AgedProspective StudiesTreatment OutcomeWaterYoung AdultWater

Identifiers

PMID31628954
PMCPMC7039760
OpenAlexW2981255080

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.