Underwater endoscopic mucosal resection is associated with fewer recurrences and earlier curative resections compared to conventional endoscopic mucosal resection for large colorectal polyps
Background Studies comparing the efficacy and safety of conventional saline-assisted piecemeal endoscopic mucosal resection (EMR) to underwater EMR (UEMR) without submucosal lifting of colorectal polyps are lacking. The objective of this study was to compare the efficacy and safety of EMR to UEMR of...
Gespeichert in:
| Veröffentlicht in: | Surgical endoscopy 2017-10, Vol.31 (10), p.4174-4183 |
|---|---|
| Hauptverfasser: | , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 4183 |
|---|---|
| container_issue | 10 |
| container_start_page | 4174 |
| container_title | Surgical endoscopy |
| container_volume | 31 |
| creator | Schenck, Robert J. Jahann, Darius A. Patrie, James T. Stelow, Edward B. Cox, Dawn G. Uppal, Dushant S. Sauer, Bryan G. Shami, Vanessa M. Strand, Daniel S. Wang, Andrew Y. |
| description | Background
Studies comparing the efficacy and safety of conventional saline-assisted piecemeal endoscopic mucosal resection (EMR) to underwater EMR (UEMR) without submucosal lifting of colorectal polyps are lacking. The objective of this study was to compare the efficacy and safety of EMR to UEMR of large colorectal polyps.
Methods
Two hundred eighty-nine colorectal polyps were removed by a single endoscopist from 7/2007 to 2/2015 using EMR or UEMR. 135 polyps (EMR: 62, UEMR: 73) that measured ≥15 mm and had not undergone prior attempted polypectomy were evaluated for rates of complete macroscopic resection and adverse events. 101 of these polyps (EMR: 46, UEMR: 55) had at least 1 follow-up colonoscopy and were studied for rates of recurrence and the number of procedures required to achieve curative resection.
Results
The rate of complete macroscopic resection was higher following UEMR compared to EMR (98.6 vs. 87.1%,
p
= 0.012). UEMR had a lower recurrence rate at the first follow-up colonoscopy compared to EMR (7.3 vs. 28.3%, OR 5.0 for post-EMR recurrence, 95% CI: [1.5, 16.5],
p
= 0.008). UEMR required fewer procedures to reach curative resection than EMR (mean of 1.0 vs. 1.3,
p
= 0.002). There was no significant difference in rates of adverse events.
Conclusions
UEMR appears superior to EMR for the removal of large colorectal polyps in terms of rates of complete macroscopic resection and recurrent (or residual) abnormal tissue. Compared to conventional EMR, UEMR may offer increased procedural effectiveness without compromising safety in the removal of large colorectal polyps without prior attempted resection. |
| doi_str_mv | 10.1007/s00464-017-5474-4 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1881269402</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1881269402</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-d9d92d0018b9b84c242a4a990e988f01585e64487309a8c55b4fc4e5baceeff53</originalsourceid><addsrcrecordid>eNp9kc2KFTEQhYMoznX0AdxIwI2b1iSd3E6WMvgHA26cdUinq8cM3Umb6p7LvJzPZl3u-IOgq4Sq75xDcRh7LsVrKUT3BoXQe90I2TVGd7rRD9hO6lY1Skn7kO2Ea0WjOqfP2BPEG0G4k-YxO1O21Uoqs2Pfr_IA9RBWqBzyUDCWJUU-b7FgmHgFhLimknlCHhBLTIQO_JDWr3yEA6kqxK1WyBGIyAOHUKdEc5qGNd3Cbw_kscxLqKRfC_3zLeTjnHL-Gz2WyqdQr4E0U6G8ldZLme4WfMoejWFCeHb_nrOr9---XHxsLj9_-HTx9rKJbafWZnCDU4MQ0vautzoqrYIOzglw1o5CGmtgr7XtWuGCjcb0eowaTB8iwDia9py9OvkutXzbAFc_J4wwTSFD2dBLa6XaOy0UoS__Qm_KVulIopx2zrSq64iSJyrWglhh9EtNc6h3Xgp_LNefyvVUrj-W6zVpXtw7b_0Mwy_FzzYJUCcAaZWvof4R_U_XH2qztVg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1949953277</pqid></control><display><type>article</type><title>Underwater endoscopic mucosal resection is associated with fewer recurrences and earlier curative resections compared to conventional endoscopic mucosal resection for large colorectal polyps</title><source>MEDLINE</source><source>Springer Online Journals Complete</source><creator>Schenck, Robert J. ; Jahann, Darius A. ; Patrie, James T. ; Stelow, Edward B. ; Cox, Dawn G. ; Uppal, Dushant S. ; Sauer, Bryan G. ; Shami, Vanessa M. ; Strand, Daniel S. ; Wang, Andrew Y.</creator><creatorcontrib>Schenck, Robert J. ; Jahann, Darius A. ; Patrie, James T. ; Stelow, Edward B. ; Cox, Dawn G. ; Uppal, Dushant S. ; Sauer, Bryan G. ; Shami, Vanessa M. ; Strand, Daniel S. ; Wang, Andrew Y.</creatorcontrib><description>Background
Studies comparing the efficacy and safety of conventional saline-assisted piecemeal endoscopic mucosal resection (EMR) to underwater EMR (UEMR) without submucosal lifting of colorectal polyps are lacking. The objective of this study was to compare the efficacy and safety of EMR to UEMR of large colorectal polyps.
Methods
Two hundred eighty-nine colorectal polyps were removed by a single endoscopist from 7/2007 to 2/2015 using EMR or UEMR. 135 polyps (EMR: 62, UEMR: 73) that measured ≥15 mm and had not undergone prior attempted polypectomy were evaluated for rates of complete macroscopic resection and adverse events. 101 of these polyps (EMR: 46, UEMR: 55) had at least 1 follow-up colonoscopy and were studied for rates of recurrence and the number of procedures required to achieve curative resection.
Results
The rate of complete macroscopic resection was higher following UEMR compared to EMR (98.6 vs. 87.1%,
p
= 0.012). UEMR had a lower recurrence rate at the first follow-up colonoscopy compared to EMR (7.3 vs. 28.3%, OR 5.0 for post-EMR recurrence, 95% CI: [1.5, 16.5],
p
= 0.008). UEMR required fewer procedures to reach curative resection than EMR (mean of 1.0 vs. 1.3,
p
= 0.002). There was no significant difference in rates of adverse events.
Conclusions
UEMR appears superior to EMR for the removal of large colorectal polyps in terms of rates of complete macroscopic resection and recurrent (or residual) abnormal tissue. Compared to conventional EMR, UEMR may offer increased procedural effectiveness without compromising safety in the removal of large colorectal polyps without prior attempted resection.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-017-5474-4</identifier><identifier>PMID: 28342125</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abdominal Surgery ; Adenomatous Polyps - pathology ; Adenomatous Polyps - surgery ; Adult ; Aged ; Aged, 80 and over ; Colon ; Colonic Polyps - pathology ; Colonic Polyps - surgery ; Colonoscopy ; Colonoscopy - methods ; Colorectal Neoplasms - pathology ; Colorectal Neoplasms - surgery ; Endoscopic Mucosal Resection - methods ; Endoscopy ; Female ; Gastroenterology ; Gynecology ; Hepatology ; Humans ; Intestinal Mucosa - pathology ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Neoplasm Recurrence, Local - surgery ; Proctology ; Retrospective Studies ; Surgery</subject><ispartof>Surgical endoscopy, 2017-10, Vol.31 (10), p.4174-4183</ispartof><rights>Springer Science+Business Media New York 2017</rights><rights>Surgical Endoscopy is a copyright of Springer, 2017.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-d9d92d0018b9b84c242a4a990e988f01585e64487309a8c55b4fc4e5baceeff53</citedby><cites>FETCH-LOGICAL-c372t-d9d92d0018b9b84c242a4a990e988f01585e64487309a8c55b4fc4e5baceeff53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-017-5474-4$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-017-5474-4$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>315,781,785,27929,27930,41493,42562,51324</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28342125$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Schenck, Robert J.</creatorcontrib><creatorcontrib>Jahann, Darius A.</creatorcontrib><creatorcontrib>Patrie, James T.</creatorcontrib><creatorcontrib>Stelow, Edward B.</creatorcontrib><creatorcontrib>Cox, Dawn G.</creatorcontrib><creatorcontrib>Uppal, Dushant S.</creatorcontrib><creatorcontrib>Sauer, Bryan G.</creatorcontrib><creatorcontrib>Shami, Vanessa M.</creatorcontrib><creatorcontrib>Strand, Daniel S.</creatorcontrib><creatorcontrib>Wang, Andrew Y.</creatorcontrib><title>Underwater endoscopic mucosal resection is associated with fewer recurrences and earlier curative resections compared to conventional endoscopic mucosal resection for large colorectal polyps</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
Studies comparing the efficacy and safety of conventional saline-assisted piecemeal endoscopic mucosal resection (EMR) to underwater EMR (UEMR) without submucosal lifting of colorectal polyps are lacking. The objective of this study was to compare the efficacy and safety of EMR to UEMR of large colorectal polyps.
Methods
Two hundred eighty-nine colorectal polyps were removed by a single endoscopist from 7/2007 to 2/2015 using EMR or UEMR. 135 polyps (EMR: 62, UEMR: 73) that measured ≥15 mm and had not undergone prior attempted polypectomy were evaluated for rates of complete macroscopic resection and adverse events. 101 of these polyps (EMR: 46, UEMR: 55) had at least 1 follow-up colonoscopy and were studied for rates of recurrence and the number of procedures required to achieve curative resection.
Results
The rate of complete macroscopic resection was higher following UEMR compared to EMR (98.6 vs. 87.1%,
p
= 0.012). UEMR had a lower recurrence rate at the first follow-up colonoscopy compared to EMR (7.3 vs. 28.3%, OR 5.0 for post-EMR recurrence, 95% CI: [1.5, 16.5],
p
= 0.008). UEMR required fewer procedures to reach curative resection than EMR (mean of 1.0 vs. 1.3,
p
= 0.002). There was no significant difference in rates of adverse events.
Conclusions
UEMR appears superior to EMR for the removal of large colorectal polyps in terms of rates of complete macroscopic resection and recurrent (or residual) abnormal tissue. Compared to conventional EMR, UEMR may offer increased procedural effectiveness without compromising safety in the removal of large colorectal polyps without prior attempted resection.</description><subject>Abdominal Surgery</subject><subject>Adenomatous Polyps - pathology</subject><subject>Adenomatous Polyps - surgery</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Colon</subject><subject>Colonic Polyps - pathology</subject><subject>Colonic Polyps - surgery</subject><subject>Colonoscopy</subject><subject>Colonoscopy - methods</subject><subject>Colorectal Neoplasms - pathology</subject><subject>Colorectal Neoplasms - surgery</subject><subject>Endoscopic Mucosal Resection - methods</subject><subject>Endoscopy</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Intestinal Mucosa - pathology</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Neoplasm Recurrence, Local - surgery</subject><subject>Proctology</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kc2KFTEQhYMoznX0AdxIwI2b1iSd3E6WMvgHA26cdUinq8cM3Umb6p7LvJzPZl3u-IOgq4Sq75xDcRh7LsVrKUT3BoXQe90I2TVGd7rRD9hO6lY1Skn7kO2Ea0WjOqfP2BPEG0G4k-YxO1O21Uoqs2Pfr_IA9RBWqBzyUDCWJUU-b7FgmHgFhLimknlCHhBLTIQO_JDWr3yEA6kqxK1WyBGIyAOHUKdEc5qGNd3Cbw_kscxLqKRfC_3zLeTjnHL-Gz2WyqdQr4E0U6G8ldZLme4WfMoejWFCeHb_nrOr9---XHxsLj9_-HTx9rKJbafWZnCDU4MQ0vautzoqrYIOzglw1o5CGmtgr7XtWuGCjcb0eowaTB8iwDia9py9OvkutXzbAFc_J4wwTSFD2dBLa6XaOy0UoS__Qm_KVulIopx2zrSq64iSJyrWglhh9EtNc6h3Xgp_LNefyvVUrj-W6zVpXtw7b_0Mwy_FzzYJUCcAaZWvof4R_U_XH2qztVg</recordid><startdate>20171001</startdate><enddate>20171001</enddate><creator>Schenck, Robert J.</creator><creator>Jahann, Darius A.</creator><creator>Patrie, James T.</creator><creator>Stelow, Edward B.</creator><creator>Cox, Dawn G.</creator><creator>Uppal, Dushant S.</creator><creator>Sauer, Bryan G.</creator><creator>Shami, Vanessa M.</creator><creator>Strand, Daniel S.</creator><creator>Wang, Andrew Y.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20171001</creationdate><title>Underwater endoscopic mucosal resection is associated with fewer recurrences and earlier curative resections compared to conventional endoscopic mucosal resection for large colorectal polyps</title><author>Schenck, Robert J. ; Jahann, Darius A. ; Patrie, James T. ; Stelow, Edward B. ; Cox, Dawn G. ; Uppal, Dushant S. ; Sauer, Bryan G. ; Shami, Vanessa M. ; Strand, Daniel S. ; Wang, Andrew Y.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-d9d92d0018b9b84c242a4a990e988f01585e64487309a8c55b4fc4e5baceeff53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Abdominal Surgery</topic><topic>Adenomatous Polyps - pathology</topic><topic>Adenomatous Polyps - surgery</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Colon</topic><topic>Colonic Polyps - pathology</topic><topic>Colonic Polyps - surgery</topic><topic>Colonoscopy</topic><topic>Colonoscopy - methods</topic><topic>Colorectal Neoplasms - pathology</topic><topic>Colorectal Neoplasms - surgery</topic><topic>Endoscopic Mucosal Resection - methods</topic><topic>Endoscopy</topic><topic>Female</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Intestinal Mucosa - pathology</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Neoplasm Recurrence, Local - surgery</topic><topic>Proctology</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Schenck, Robert J.</creatorcontrib><creatorcontrib>Jahann, Darius A.</creatorcontrib><creatorcontrib>Patrie, James T.</creatorcontrib><creatorcontrib>Stelow, Edward B.</creatorcontrib><creatorcontrib>Cox, Dawn G.</creatorcontrib><creatorcontrib>Uppal, Dushant S.</creatorcontrib><creatorcontrib>Sauer, Bryan G.</creatorcontrib><creatorcontrib>Shami, Vanessa M.</creatorcontrib><creatorcontrib>Strand, Daniel S.</creatorcontrib><creatorcontrib>Wang, Andrew Y.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schenck, Robert J.</au><au>Jahann, Darius A.</au><au>Patrie, James T.</au><au>Stelow, Edward B.</au><au>Cox, Dawn G.</au><au>Uppal, Dushant S.</au><au>Sauer, Bryan G.</au><au>Shami, Vanessa M.</au><au>Strand, Daniel S.</au><au>Wang, Andrew Y.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Underwater endoscopic mucosal resection is associated with fewer recurrences and earlier curative resections compared to conventional endoscopic mucosal resection for large colorectal polyps</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2017-10-01</date><risdate>2017</risdate><volume>31</volume><issue>10</issue><spage>4174</spage><epage>4183</epage><pages>4174-4183</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
Studies comparing the efficacy and safety of conventional saline-assisted piecemeal endoscopic mucosal resection (EMR) to underwater EMR (UEMR) without submucosal lifting of colorectal polyps are lacking. The objective of this study was to compare the efficacy and safety of EMR to UEMR of large colorectal polyps.
Methods
Two hundred eighty-nine colorectal polyps were removed by a single endoscopist from 7/2007 to 2/2015 using EMR or UEMR. 135 polyps (EMR: 62, UEMR: 73) that measured ≥15 mm and had not undergone prior attempted polypectomy were evaluated for rates of complete macroscopic resection and adverse events. 101 of these polyps (EMR: 46, UEMR: 55) had at least 1 follow-up colonoscopy and were studied for rates of recurrence and the number of procedures required to achieve curative resection.
Results
The rate of complete macroscopic resection was higher following UEMR compared to EMR (98.6 vs. 87.1%,
p
= 0.012). UEMR had a lower recurrence rate at the first follow-up colonoscopy compared to EMR (7.3 vs. 28.3%, OR 5.0 for post-EMR recurrence, 95% CI: [1.5, 16.5],
p
= 0.008). UEMR required fewer procedures to reach curative resection than EMR (mean of 1.0 vs. 1.3,
p
= 0.002). There was no significant difference in rates of adverse events.
Conclusions
UEMR appears superior to EMR for the removal of large colorectal polyps in terms of rates of complete macroscopic resection and recurrent (or residual) abnormal tissue. Compared to conventional EMR, UEMR may offer increased procedural effectiveness without compromising safety in the removal of large colorectal polyps without prior attempted resection.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>28342125</pmid><doi>10.1007/s00464-017-5474-4</doi><tpages>10</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0930-2794 |
| ispartof | Surgical endoscopy, 2017-10, Vol.31 (10), p.4174-4183 |
| issn | 0930-2794 1432-2218 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1881269402 |
| source | MEDLINE; Springer Online Journals Complete |
| subjects | Abdominal Surgery Adenomatous Polyps - pathology Adenomatous Polyps - surgery Adult Aged Aged, 80 and over Colon Colonic Polyps - pathology Colonic Polyps - surgery Colonoscopy Colonoscopy - methods Colorectal Neoplasms - pathology Colorectal Neoplasms - surgery Endoscopic Mucosal Resection - methods Endoscopy Female Gastroenterology Gynecology Hepatology Humans Intestinal Mucosa - pathology Male Medicine Medicine & Public Health Middle Aged Neoplasm Recurrence, Local - surgery Proctology Retrospective Studies Surgery |
| title | Underwater endoscopic mucosal resection is associated with fewer recurrences and earlier curative resections compared to conventional endoscopic mucosal resection for large colorectal polyps |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-15T13%3A32%3A58IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Underwater%20endoscopic%20mucosal%20resection%20is%20associated%20with%20fewer%20recurrences%20and%20earlier%20curative%20resections%20compared%20to%20conventional%20endoscopic%20mucosal%20resection%20for%20large%20colorectal%20polyps&rft.jtitle=Surgical%20endoscopy&rft.au=Schenck,%20Robert%20J.&rft.date=2017-10-01&rft.volume=31&rft.issue=10&rft.spage=4174&rft.epage=4183&rft.pages=4174-4183&rft.issn=0930-2794&rft.eissn=1432-2218&rft_id=info:doi/10.1007/s00464-017-5474-4&rft_dat=%3Cproquest_cross%3E1881269402%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1949953277&rft_id=info:pmid/28342125&rfr_iscdi=true |