Clin Endosc.  2021 May;54(3):371-378. 10.5946/ce.2020.147.

Efficacy of Underwater Endoscopic Mucosal Resection for Superficial Non-Ampullary Duodenal Epithelial Tumor

• Furukawa M
• Mitoro A
• Ozutumi T
• Fujinaga Y
• Nakanishi K
• Kitagawa K
• Saikawa S
• Sato S
• Sawada Y
• Takaya H
• Kaji K
• Kawaratani H
• Namisaki T
• Moriya K
• Akahane T
• Yamao J
• Yoshiji H

• KMID: 2516317
• DOI: http://doi.org/10.5946/ce.2020.147

Abstract

Background/Aims
Endoscopic resection (ER) for superficial non-ampullary duodenal epithelial tumors (SNADETs) is challenging. Conventional endoscopic mucosal resection (CEMR) is also problematic due to the anatomical features of the duodenum. We compared the safety and efficacy of underwater endoscopic mucosal resection (UEMR) with those of CEMR through a retrospective analysis.
Methods
Altogether, 44 consecutive patients with 46 SNADETs underwent ER (18 CEMR cases and 28 UEMR cases) between January 2016 and October 2019. We investigated the proportions of en bloc resection, R0 resection, complications, resection time, and total procedure time and compared the outcomes of patients from the CEMR group with those of patients from the UEMR group.
Results
The median tumor size was 8.0 mm (range, 2.0–20.0 mm). The UEMR group showed a higher proportion of en bloc resection (96.4% vs. 72.2%, p<0.05) and significantly lower median resection time and total procedure time (4 min vs. 9.5 min, p<0.05 and 13 min vs. 19 min, p<0.05; respectively) than the CEMR group. No complications were observed. However, two patients treated with piecemeal resection in the CEMR group had residual tumors.
Conclusions
UEMR is a feasible therapeutic option for SNADETs. It can be recommended as a standard treatment.

Keyword

Duodenal epithelial tumor; Endoscopic resection; Superficial non-ampullary duodenal epithelial tumor; Underwater endoscopic mucosal resection

Figure

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  Fig. 1. Underwater endoscopic mucosal resection for a duodenal intramucosal adenocarcinoma sized 11 mm. (A) Upper gastrointestinal endoscopy revealed an elevated lesion in the inferior duodenal angle. (B, C) The lesion floated up and became easy to snare in the submerged condition. (D) Ulcer after underwater endoscopic mucosal resection. (E) Complete closure with endoclips (EZ clip; Olympus, Tokyo, Japan).

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