Feasibility of underwater endoscopic mucosal resection and management of residues for superficial non‐ampullary duodenal epithelial neoplasms

Abstract

Background and Aim: Underwater endoscopic mucosal resection (UEMR) is effective for superficial non-ampullary duodenal epithelial neoplasms (SNADEN). However, the incidence of residual lesion after UEMR, especially for large lesions (≥20 mm), and their prognosis remain unclear. We aimed to assess the incidence of residual lesions and further outcomes after UEMR for SNADEN. Methods:We carried out a retrospective study at a tertiary cancer institute. Candidates for the study were systematically retrieved from an endoscopic and pathological database from Results: A total of 162 SNADEN resected with UEMR were analyzed. Median (range) procedure time was 5 (1-70) min. En bloc resection rates for large lesions (≥20 mm) and small lesions (<20 mm) were 14% and 79%, respectively. Intraprocedural bleeding occurred in one (0.6%) case, but no intraprocedural perforation occurred during the study. Delayed bleeding occurred in two (1.2%) cases and delayed perforation occurred in one (0.6%) case. A total of 157 (97%) lesions were followed up by at least one endoscopic examination. Of these lesions, residual lesions were recognized in seven cases (5%). Additional UEMR was carried out in five lesions and underwater cold snare polypectomy in one lesion. One lesion was observed without additional treatment. After salvage intervention, no cases experienced further residual lesions. Conclusion:Although UEMR for SNADEN can be relevant when other efficacious procedures are unavailable, careful follow up for residual lesions is required especially after piecemeal resection for large lesions.

The incidence of non‐ampullary duodenal cancer in Japan: The first analysis of a national cancer registry

“…Advanced duodenal cancer has a poor prognosis 7 ; therefore, early detection is required. Favorable short‐term and long‐term outcomes of endoscopic treatment at early stages were reported in Japan 19–24 . Our study results indicated that conducting screenings in individuals aged <80 years would contribute to the early detection of this disease and an improvement in its prognosis.…”

Underwater endoscopic mucosal resection for neoplasms in the pyloric ring of the stomach: Four case reports

“…Our case series suggested the potential of UEMR for the treatment of neoplasms located in the pyloric ring. UEMR, with a relative short procedure time and low rate of adverse events, does not require high technical skills in endoscopic procedures[ 6 ]. UEMR for the management of neoplasms in the pyloric ring has benefits similar to those of UEMR for colorectal neoplasms: (1) Superficial lesions float into the snare as protruding lesions in underwater conditions; (2) UEMR decreases the thermal damage to the gastrointestinal wall, which helps prevent delayed perforation; and (3) The resection plane in UEMR is superficial; thus, the submucosal vessels usually remain within the resection wound, whereas in conventional EMR, the submucosal vessels are disrupted[ 2 ].…”

“…Recently, underwater endoscopic mucosal resection (UEMR) was suggested by Binmoeller et al[ 1 ], which has been used in the treatment of challenging lesions in the duodenum and colorectum near the appendiceal orifice and dentate line; UEMR has shown good treatment results with a high complete resection rate and low adverse event rate[ 2 - 5 ]. UEMR has also been adapted for recurrent or residual lesions after endoscopic resection[ 6 , 7 ]. Here, we reported our experience of using UEMR for benign mucosal neoplasms located in the pyloric ring.…”

Underwater endoscopic mucosal resection for a large polyp in the terminal ileum

“…Underwater endoscopic mucosal resection (UEMR) is reportedly efficacious and safe to remove colorectal and duodenal polyps, including intra‐mucosal cancers 1–5 . However, information on UEMR in the terminal ileum is lacking.…”