Clinical Endoscopy

Review

Current Treatment Strategy for Superficial Nonampullary Duodenal Epithelial Tumors: Tetsuya Suwa, Kohei Takizawa, Noboru Kawata, Masao Yoshida, Yohei Yabuuchi, Yoichi Yamamoto, Hiroyuki Ono; Clin Endosc 2022;55(1):15-21. Published online September 29, 2021; DOI: https://doi.org/10.5946/ce.2021.141

Endoscopic submucosal dissection (ESD) is the standard treatment method for esophageal, gastric, and colorectal cancers. However, it has not been standardized for duodenal lesions because of its high complication rates. Recently, minimally invasive and simple methods such as cold snare polypectomy and underwater endoscopic mucosal resection have been utilized more for superficial nonampullary duodenal epithelial tumors (SNADETs). Although the rate of complications associated with duodenal ESD has been gradually decreasing because of technical advancements, performing ESD for all SNADETs is unnecessary. As such, the appropriate treatment plan for SNADETs should be chosen according to the lesion type, patient condition, and endoscopist’s skill.

Citations

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Original Article

Efficacy of Underwater Endoscopic Mucosal Resection for Superficial Non-Ampullary Duodenal Epithelial Tumor: Masanori Furukawa, Akira Mitoro, Takahiro Ozutumi, Yukihisa Fujinaga, Keisuke Nakanishi, Koh Kitagawa, Soichiro Saikawa, Sinya Sato, Yasuhiko Sawada, Hiroaki Takaya, Kosuke Kaji, Hideto Kawaratani, Tadashi Namisaki, Kei Moriya, Takemi Akahane, Junichi Yamao, Hitoshi Yoshiji; Clin Endosc 2021;54(3):371-378. Published online February 18, 2021; DOI: https://doi.org/10.5946/ce.2020.147

Abstract PDF PubReader ePub

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.

Citations

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Underwater Endoscopic Mucosal Resection Vs Conventional Endoscopic Mucosal Resection for Superficial Nonampullary Duodenal Epithelial Tumors in the Western Setting
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Clinical Gastroenterology and Hepatology.2024;[Epub] CrossRef
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Sandro Sferrazza, Giulio Calabrese, Roberta Maselli, Rui Morais, Antonio Facciorusso, Georgios Mavrogenis, Roberto Di Mitri, Alessandro Repici, Marcello Maida
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Xiu-He Lv, Rong Luo, Qing Lu, Kai Deng, Jin-Lin Yang
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Jae Gon Lee, Sang Pyo Lee, Hyun Joo Jang, Sea Hyub Kae
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Jixiang Liu, Shaojie Duan, Yichong Wang, Hongye Peng, Youjia Kong, Shukun Yao
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Reply
Yasushi Yamasaki, Noriya Uedo
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Reply to Lv and Yang
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Endoscopy.2022; 54(05): 523. CrossRef
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Yosuke Toya, Masaki Endo, Masanao Yamazato, Shun Yamada, Tomo Kumei, Minami Hirai, Makoto Eizuka, Toshifumi Morishita, Risaburo Akasaka, Shunichi Yanai, Noriyuki Uesugi, Tamotsu Sugai, Takayuki Matsumoto
Journal of Gastroenterology and Hepatology.2021; 36(11): 3191. CrossRef

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Case Report

Underwater Endoscopic Mucosal Resection without Submucosal Injection Facilitates En bloc Resection of Colon Adenomas Extending into a Diverticulum: Yoshikazu Hayashi, Masahiro Okada, Takaaki Morikawa, Tatsuma Nomura, Hisashi Fukuda, Takahito Takezawa, Alan Kawarai Lefor, Hironori Yamamoto; Clin Endosc 2021;54(3):436-440. Published online November 6, 2020; DOI: https://doi.org/10.5946/ce.2020.168

Abstract PDF Supplementary Material PubReader ePub

Superficial colonic neoplasms sometimes extend into a diverticulum. Conventional endoscopic mucosal resection of these lesions is considered challenging because colonic diverticula do not have a muscularis propria and are deeply inverted. Even if the solution is carefully injected below the mucosa at the bottom of the diverticulum, the mucosa is rarely elevated from the diverticular orifice, and it is usually just narrowed. Although endoscopic submucosal dissection or full-thickness resection with an over-the-scope clip device enables the complete resection of these lesions, it is still challenging, time consuming and expensive. Underwater endoscopic mucosal resection without submucosal injection (UEMR) is an innovative technique enabling en bloc resection of superficial colon lesions. We report three patients with colon adenomas extending into a diverticulum treated with successful UEMR. UEMR enabled rapid and safe en bloc resection of colon lesions extending into a diverticulum.

Citations

Citations to this article as recorded by

Underwater endoscopic mucosal resection for colorectal lesions: Can it be an “Underwater” revolution?
Yoji Takeuchi, Satoki Shichijo, Noriya Uedo, Ryu Ishihara
DEN Open.2022;[Epub] CrossRef

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122 Download
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