“…It is crucial to note that even when using laparoscopic and endoscopic cooperative surgery, basic endoscopic submucosal dissection techniques remain necessary. Although there have been advances in various technologies that are expected to be used in clinical practice, 8,9 such as local injection of solutions promoting tissue repair after perforation, endoscopic treatment of the duodenum remains the most challenging technique. The study by Morita et al 4 is based on data from a high-volume center in Japan; however, given the inherently low incidence of duodenal cancer, achieving standardization in treatment is challenging.…”