Anchoring the snare tip using a small incision in the submucosa facilitates en bloc endoscopic mucosal resection for sporadic duodenal adenomas

Forté, Emmanuel; Jacques, J.; Rivory, Jérôme; Rostain, Florian; Saurin, Jean‐Christophe; Ponchon, Thierry; Pioche, Mathieu

doi:10.1055/s-0043-120061

Cited by 4 publications

(5 citation statements)

References 5 publications

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“…To tackle the above described issue, we developed a modified duodenoscopic papillomaectomy which we also called duodenal papilla adenoma fenestration to increase en bloc resection rate and to reduce recurrence and residual risk [ 10 ]. Compared to the report of two cases with sporadic duodenal adenomas in that anchoring the snare tip with a small incision in the submucosa facilitates en bloc endoscopic mucosal [ 11 ], our approach has the following differences: we focused on the duodenal major papilla adenoma with an increased sample size and employed a duodenoscopy instead of an esophago-gastro-duodenoscopy to carry out the procedure. The use of duodenoscopy has several advantages: (1) Side-view endoscope makes it easier to get a glimpse of the entire appearance of the papilla and adenomas, especially to identify the location of the papilla openings; (2) Skilled endoscopists can adjust the injection needle, snare and titanium by means of the forcep elevators and angulation knob to complete the procedure under direct-vision; (3) After the adenoma is removed, the direct insertion of the biliary and pancreatic ducts can be achieved without the replacement of the endoscope.…”

Section: Discussionmentioning

confidence: 99%

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Outcome of a novel modified endoscopic papillectomy for duodenal major papilla adenoma

et al. 2020

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Background and aims In recent years, with the development of endoscopic techniques, endoscopic resection is widely used for duodenal papillary adenomas, but conventional endoscopic resection has a high rate of incomplete resection and recurrence. On this basis, we have employed a novel modified endoscopic papillectomy (ESP). In this study, we evaluated the feasibility and advantages of this ESP for the treatment of duodenal major papilla adenoma. Methods A total of 56 patients with duodenal major papilla adenoma confirmed by endoscopic ultrasonography, intraluminal ultrasound and gastroscopic biopsy from October 2007 to June 2017 were collected in the Department of Gastroenterology, Nanjing Drum Tower Hospital. The diameter of the adenoma ranged from 1.41 to 2.02 cm. 16 cases were given the conventional method and 40 cases underwent the modified ESP procedure in which a small incision was made by cutting current when anchoring the snare tip on the distal side of the adenoma. Results En bloc resection rate was significantly higher in the modified group (100%, 40/40) than that in the conventional group (81.3%, 13/16; P = 0.02). However, no significance was seen between the modified group and the conventional group in complete resection rate (92.5%, 37/40 vs 93.8%, 15/16; P = 1.00). There was no significant difference in the number and difficulty of postoperative pancreatic and biliary stents placement between the two groups (P = 0.20). Total bleeding occurrence was much lower in the modified group (37.5%, 15/40 vs 87.5%, 14/16; P = 0.001), and no significant differences were found in other short-term complications and the 3, 6, 12 and 24 months recurrences rate between the conventional and modified ESP groups. Conclusions The modified ESP improves the treatment outcome of duodenal major papilla adenoma with higher en bloc resection rate and lowering bleeding rate.

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Section: Discussionmentioning

confidence: 99%

“…The snare was then opened in a circular shape and held in place without slippage, which could enable the resection of the lesion en bloc [ 10 ]. Later, a similar approach was used to treat sporadic duodenal adenomas by Forte et al [ 11 ].…”

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confidence: 99%

Outcome of a novel modified endoscopic papillectomy for duodenal major papilla adenoma

et al. 2020

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“…It is particularly difficult to achieve en bloc resection for SDETs of > 15 mm in size 3 , because such lesions straddle at least two folds and cannot be precisely grasped by the snare. Anchoring the snare tip to the duodenal mucosa to fix it in place has been tried 4 ; however, there may be problems achieving an en bloc resection with this method. We previously reported that saline injection into a duodenal fold promotes a protruded form of the mucosa 5 .…”

Section: Figmentioning

confidence: 99%

Underwater endoscopic mucosal resection aided by a protruding anchor created by saline injection into the distal duodenal fold

et al. 2023

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“…Conversely, anchored snare-tip EMR or 'Tip-in' EMR is a modified technique that anchors the snare-tip into a mucosal slit to prevent slipping of the snare while capturing a lesion [21,22]. According to previous studies, Tip-in EMR achieves higher complete resection rates of colorectal neoplasia compared to that of conventional EMR [23][24][25][26].…”

Section: Introductionmentioning

confidence: 99%

Endoscopic mucosal resection using anchored snare Tip-in versus precut technique for small rectal neuroendocrine tumors

Hong,

Yang,

Lee

et al. 2024

Korean J Intern Med

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Background/Aims: Small rectal neuroendocrine tumors (NETs) can be treated with modified endoscopic mucosal resection (EMR). However, an optimal EMR method remains to be established. We aimed to assess the non-inferiority of Tip-in EMR versus precut EMR (EMR-P) for treating rectal NETs.Methods: This prospective, multicenter, randomized controlled trial enrolled patients with rectal NETs of < 10 mm in diameter. The patients were randomly assigned to EMR-P and Tip-in EMR groups in a 1:1 ratio. Primary outcome was margin-negative (R0) resection rate between the two methods, with a noninferiority margin of 10%.Results: Seventy-five NETs in 73 patients, including 64 eligible lesions (32 lesions in each, EMR-P and Tip-in EMR groups), were evaluated. In a modified intention-to-treat analysis, R0 resection rates of the EMR-P and Tip-in EMR groups were 96.9% and 90.6%, respectively, which did not demonstrate non-inferiority (risk difference, -6.3 [95% confidence interval: -18.0 to 5.5]). Resection time in the EMR-P group was longer than that in the Tip-in EMR group (p < 0.001). One case of intraprocedural bleeding was reported in each group.Conclusions: We did not demonstrate the non-inferiority of Tip-in EMR compared to EMR-P for treating small rectal NETs. However, the R0 resection rates for both techniques were high enough for clinical application.

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Anchoring the snare tip using a small incision in the submucosa facilitates en bloc endoscopic mucosal resection for sporadic duodenal adenomas

Cited by 4 publications

References 5 publications

Outcome of a novel modified endoscopic papillectomy for duodenal major papilla adenoma

Outcome of a novel modified endoscopic papillectomy for duodenal major papilla adenoma

Underwater endoscopic mucosal resection aided by a protruding anchor created by saline injection into the distal duodenal fold

Endoscopic mucosal resection using anchored snare Tip-in versus precut technique for small rectal neuroendocrine tumors

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