Underwater endoscopic mucosal resection for superficial nonampullary duodenal adenomas

Yamasaki, Yasushi; Uedo, Noriya; Takeuchi, Yoji; Higashino, Koji; Hanaoka, Noboru; Akasaka, Tomofumi; Kato, Mototsugu; Hamada, Kaoru; Tonai, Yusuke; Matsuura, Noriko; Kanesaka, Takashi; Arao, Masamichi; Suzuki, Shinichi; Iwatsubo, Taro; Shichijo, Satoki; Nakahira, Hiroko; Ishihara, Ryu; Iishi, Hiroyasu

doi:10.1055/s-0043-119214

Cited by 81 publications

(107 citation statements)

References 14 publications

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“…In Japan, UEMR has been basically used for SNADETs ≤20 mm. The recurrence rate after UEMR was only 3% (mean size, 12.0 mm), and neither bleeding nor perforation occurred [24]. Theoretically, UEMR is safe because the underwater procedure decreases thermal damage to the duodenal wall and the submucosa is cut more shallowly with UEMR compared with EMR.…”

Section: Characteristics and Treatment Outcome Of Each Er Methodsmentioning

confidence: 99%

“…Underwater EMR (UEMR) was developed in a Western country, and it is currently used to treat patients with SNADETs [22-24]. UEMR may overcome the deficiency of EMR or ESD, and it seems to be useful for small SNADETs with low recurrence and adverse event rates [24].…”

Section: Introductionmentioning

confidence: 99%

“…UEMR may overcome the deficiency of EMR or ESD, and it seems to be useful for small SNADETs with low recurrence and adverse event rates [24]. We started UEMR for SNADETs at the beginning of 2014 [24], but its outcome for large lesions remains unclear. We describe the various ER methods for SNADETs, and evaluate the outcome of each ER method based on the lesion size.…”

Section: Introductionmentioning

confidence: 99%

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Current Status of Endoscopic Resection for Superficial Nonampullary Duodenal Epithelial Tumors

et al. 2018

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Background: Endoscopic resection (ER) is becoming the first choice of treatment for treating superficial nonampullary duodenal epithelial tumors (SNADETs), but ER procedures for SNADETs remain challenging because of the difficulty experienced in maneuvering the endoscope toward the thin duodenal wall, which results in a high rate of adverse events. Although several ER methods were used to overcome these technical difficulties and complications, ER methods for SNADETs are not standardized. A new technique, underwater endoscopic mucosal resection (UEMR), was developed recently in a western country, and its usefulness was reported. Beginning in 2014, we were the first to use UEMR for SNADETs in Japan. Thus, in our experience, we would propose an indication of the various ER methods for SNADETs according to the lesion size. Summary: Endoscopic mucosal resection (EMR) and UEMR were effective and safe for small lesions (≤20 mm), but for large lesions (>20 mm), piecemeal removal of lesion by EMR and UEMR had high incidence of recurrence and adverse events. Especially, piecemeal EMR could cause delayed perforation. Cold snare polypectomy was useful for small lesions (≤10 mm), but further study of its recurrence is warranted. Endoscopic submucosal dissection (ESD) achieved a high complete resection rate regardless of the lesion size, but its rate of adverse events, including morbid complications, was high. Thus, after ESD for large lesions, secure prevention method for adverse events, such as closure of the wound by laparoscopic-endoscopic cooperative surgery, should be required. Key Messages: ER methods for treating SNADETs were proposed based on the lesion size. For large lesions, prophylactic methods for adverse events should be implemented.

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Section: Characteristics and Treatment Outcome Of Each Er Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Current Status of Endoscopic Resection for Superficial Nonampullary Duodenal Epithelial Tumors

et al. 2018

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“…For 1-2 cm SNADETs, EMR is still the first choice endoscopic treatment; however, it is sometimes difficult to obtain successful results due to insufficient lifting after the submucosal injection. Underwater EMR [12][13][14], originally described by Binmoeller et al [14], is a unique technique that snares and resects the target lesion under water without lifting by local injection. Since the intestinal tract is not stretched by insufflation, capturing target lesions up to 2 cm in size within water is expected to be easier even in the duodenum and should result in a successful outcome [12][13][14].…”

Section: Treatment Methodsmentioning

confidence: 99%

“…Underwater EMR [12][13][14], originally described by Binmoeller et al [14], is a unique technique that snares and resects the target lesion under water without lifting by local injection. Since the intestinal tract is not stretched by insufflation, capturing target lesions up to 2 cm in size within water is expected to be easier even in the duodenum and should result in a successful outcome [12][13][14]. To prevent major invasive surgeries such as pancreaticoduodenectomy, ESD can be performed for large lesions that are unresectable by other endoscopic resection techniques.…”

Section: Treatment Methodsmentioning

confidence: 99%

Current Status and Challenges of Endoscopic Treatments for Duodenal Tumors

et al. 2018

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Background: Superficial tumors of the duodenum, other than ampullary tumors, have been traditionally considered rare. However, reports of this kind of tumor have increased in recent times, and the demand for minimally invasive treatments have also increasing. Summary: Adenomas and intramucosal carcinomas are target lesions for treatment. A preoperative diagnosis has not been established, but unnecessary biopsies increase the difficulty of treatment and should be avoided. Cold snare polypectomy, endoscopic mucosal resection (EMR), and underwater EMR are treatment options for small lesions. Endoscopic submucosal dissection enables secure resection even for large lesions, but it is technically demanding and associated with a higher complication rate. After endoscopic resections, exposure of digestive juices is believed to cause delayed complications. To prevent these complications, several closing and covering methods are proposed, with favorable clinical results. Key message: A treatment method should be chosen based on each patient’s situation. With any of the treatment methods, post-resection measures are required to prevent delayed complications. Secure closure of resection wounds seems promising.

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Can underwater endoscopic mucosal resection be an alternative to conventional endoscopic mucosal resection for superficial non‐ampullary duodenal epithelial tumors?

Tanaka,

Urabe,

Takemoto

et al. 2023

DEN Open

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ObjectivesUnderwater endoscopic mucosal resection (UEMR) is a simpler procedure for superficial non‐ampullary duodenal epithelial tumors (SNADET) than conventional endoscopic mucosal resection (cEMR). This study aimed to evaluate whether cEMR can be substituted by UEMR for SNADET in terms of effectiveness, safety, and learning curve.MethodsA total of 157 consecutive patients with 203 SNADETs ≤20 mm in diameter, including 107 lesions resected by cEMR and 96 lesions resected by UEMR, between January 2019 and May 2023, were retrospectively recruited. The treatment outcomes were compared between the cEMR and UEMR groups. The risk factors for incomplete resection by UEMR were analyzed using univariate and multivariate analyses. Lesions in the UEMR group were divided chronologically into five periods; thereafter, the en bloc resection rate and procedure time were compared.ResultsNo significant differences existed between the cEMR and UEMR groups in the mean procedure time (3.9 min vs. 3.6 min, p = 0.1380) or en bloc resection rate (91% vs. 94%, p = 0.4138). No perforation was observed in either group. Tumor size was an independent risk factor for incomplete resection using UEMR (p < 0.01). The history of biopsy was not associated with incomplete resection using UEMR. The en bloc resection rate of UEMR was 100% (20/20) in the first period and ranged from 90% to 100% over all periods.ConclusionUEMR is safe and effective for SNADET ≤20 mm, regardless of a history of biopsy, and is easy to learn. Thus, UEMR can serve as an alternative to cEMR.

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Underwater endoscopic mucosal resection for superficial nonampullary duodenal adenomas

Abstract: UEMR is efficacious for the treatment of small duodenal adenomas, but further large-scale trials are warranted to confirm these results.

Cited by 81 publications

References 14 publications

Current Status of Endoscopic Resection for Superficial Nonampullary Duodenal Epithelial Tumors

Current Status of Endoscopic Resection for Superficial Nonampullary Duodenal Epithelial Tumors

Current Status and Challenges of Endoscopic Treatments for Duodenal Tumors

Can underwater endoscopic mucosal resection be an alternative to conventional endoscopic mucosal resection for superficial non‐ampullary duodenal epithelial tumors?

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