Gel Immersion Endoscopic Mucosal Resection (EMR) for Superficial Nonampullary Duodenal Epithelial Tumors May Reduce Procedure Time Compared with Underwater EMR (with Video)

Abstract

Background/Aims. Underwater endoscopic mucosal resection (UEMR) has recently attracted attention as a safe and effective method for superficial nonampullary duodenal epithelial tumors (SNADETs). However, water is a fluid and it does not remain in all areas, and because it mixes easily with other substances, it sometimes becomes cloudy and reduces visibility. A new endoscopic gel product that does not mix with fluids and tends to remain in the injected area has recently been applied to EMR and is known as gel immersion EMR (GIEMR) or under-gel EMR. Here, we evaluated the endoscopic outcomes of UEMR and GIEMR. Materials and Methods. This was a retrospective cohort study conducted in two municipal hospitals. We identified 24 patients with SNADETs of 3–18 mm in diameter who underwent UEMR or GIEMR. One lesion was excluded from the analysis because it was found to be in the stomach after surgery. The primary outcome was procedure time. Results. GIEMR significantly reduced the procedure time compared with UEMR (5 min vs. 10 min, P = 0.016 ). There was no significant difference between the UEMR and GIEMR groups for en bloc resection rate (93% vs. 100%, P = 1.0 ) and R0 resection rate (57% vs. 80%, P = 0.39 ). No serious complications were observed in either group. Conclusions. GIEMR of SNADET has the potential to reduce procedure time compared with UEMR and may be particularly effective in areas where immersion in water is difficult.

Efficacy and safety of underwater endoscopic mucosal resection for ≤20 mm superficial non-ampullary duodenal epithelial tumors: Systematic review and meta-analysis

“…From an initial 1,395 studies, 496 studies were removed as they were duplicates and another 837 studies after screening title and abstract. Ten studies with 648 tumors were included in the final meta-analysis (20)(21)(22)(23)(24)(25)(26)(27)(28)(29). A total of 648 polyps that were ≤20 mm in size were resected by UEMR.…”

Efficacy and Safety of Gel Immersion Endoscopic Mucosal Resection for Non-Pedunculated Colorectal Polyps

“…Since then, the benefits of GIEMR have been reported. Although not colorectal, a retrospective study comparing GIEMR and UEMR for the resection of a superficial non-ampullary duodenal epithelial tumor reported a superior R0 resection rate for GIEMR, with a shorter procedure time [ 30 , 31 ]. According to these studies, GIEMR can reduce the procedure time compared to UEMR because gel facilitates a clear visual field more rapidly.…”

Gel immersion endoscopic papillectomy using a double-balloon endoscope to resect an ampullary tumor

“…The technique of gel immersion has recently been developed as a solution for these problems in endoscopic treatment 2 . We present here the first report of successful gel immersion endoscopic papillectomy (GI-EP) carried out using a double-balloon endoscope (DBE) to resect an ampullary tumor in a patient with surgically altered anatomy.…”

“…The usefulness of underwater endoscopic papillectomy for treating ampullary tumors in patients with surgically altered anatomy has been reported [1], but difficulties in managing the water flow in the gastrointestinal tract, and the nature of water, which mixes with blood and bile, thus impairing the endoscopic view, remained to be overcome. The technique of gel immersion has recently been developed as a solution for these problems in endoscopic treatment [2]. We present here the first report of successful gel immersion endoscopic papillectomy (GI-EP) carried out using a double-balloon endoscope (DBE) to resect an ampullary tumor in a patient with surgically altered anatomy.…”