Endoscopic Mucosal Resection Performed Underwater for Nonampullary Duodenal Epithelial Tumor: Evaluation of Feasibility and Safety

Abstract

Objectives Recently, opportunities to encounter superficial nonampullary duodenal epithelial tumor (SNADET) have increased. EMR and ESD are performed to treat SNADET. However, the rate of perforation is higher than that of other gastrointestinal lesions, regardless of which method is used. Underwater EMR (UW-EMR) is immersion treatment of SNADET, which has low risk of perforation and can remove lesions safely and completely. In the present study, we retrospectively investigated patients in whom UW-EMR was performed to evaluate the feasibility and safety of UW-EMR for the treatment of SNADET. Methods The primary endpoint was to evaluate the feasibility of UW-EMR for the treatment of SNADET, and secondary objective was to determine the operation's safety. Results There were 14 participants, with a total of 16 lesions, who underwent UW-EMR between August 2015 and December 2017. Histological heteromorphism revealed that seven patients had low-grade adenoma, seven had high-grade adenoma, and two had adenocarcinoma. En bloc resection was performed in 14 lesions. In two patients, nodular lesions were observed in the scar and biopsy confirmed recurrences. There were no serious adverse events including bleeding or perforation. Conclusions UW-EMR may be a safe and effective treatment method for SNADET, if its therapeutic indication is adequately considered.

Feasibility study comparing underwater endoscopic mucosal resection and conventional endoscopic mucosal resection for superficial non‐ampullary duodenal epithelial tumor < 20 mm

“…In previous reports, UEMR was reported to be safe, even without the use of submucosal injection. [16][17][18] However, these studies included fewer than 31 cases, even in the largest case series. It was impossible to accurately estimate the incidence rate of perforation.…”

“…However, there is a concern that the risk of perforations might increase. Although some studies have indicated that UEMR can be done safely, even for duodenal lesions, [16][17][18] these studies included a relatively small number of cases; therefore, they did not permit a discussion of complications with low incidence rates. Consequently, detailed treatment outcomes of UEMR and appropriate treatment strategies for small SNADET are unclear.…”

A Case of Duodenal Tumor Adjacent to the Diverticulum That Was Resected by the Technique of Partial Submucosal Injection Combined with Underwater Endoscopic Mucosal Resection

“…The strategy of endoscopic treatment for duodenal tumor has been controversial because of insufficient evidence. It has been reported that simple UEMR using floating force underwater condition is useful and safe even for duodenal tumor with non-lifting sign [7, 8]. However, we reported that en bloc resection rate of UEMR is significantly lower than EMR for duodenal tumor [9].…”

Innovative therapeutic endoscopy in the upper gastrointestinal tract: Review of Japan Gastroenterological Endoscopic Society Core Sessions

“…Recently, cold snare polypectomy (CSP), which does not involve local injection nor the use of an electrosurgical generator, 5,6 and underwater EMR (UEMR), in which snaring is performed under water without local injection to the submucosal layer, 7,8 have been performed. Criteria for each procedure are being established.…”