‘Underwater endoscopic mucosal resection with submucosal injection and marking’ for superficial non-ampullary duodenal epithelial tumors to achieve R0 resection: a single-center case series

Abstract

Objectives

To describe an endoscopic technique named ‘underwater endoscopic mucosal resection (UEMR) with submucosal injection and marking (UEMR-SIM)’ and to evaluate the therapeutic characteristics of superficial non-ampullary duodenal epithelial tumors (SNADETs) < 20 mm vis-a-vis classical EMR (CEMR) and UEMR techniques.

Materials and methods

This retrospective study included 103 consecutive SNADET patients (103 lesions) who underwent CEMR, UEMR, or UEMR-SIM. The UEMR-SIM procedure included (1) marking and submucosal injection, (2) filling of the duodenal lumen with 0.9% saline, (3) snaring of the lesion, and (4) electrosurgical removal. The procedural outcomes were compared between the UEMR-SIM and other-procedure groups.

Results

The en bloc resection rate was significantly higher in the UEMR-SIM group (100%) than in the CEMR group (76.8%) (p = 0.015) but was not statistically different between the UEMR-SIM and UEMR groups (88.0%) (p = 0.236). The R0 resection rate was significantly higher in the UEMR-SIM group (90.9%) than in the UEMR group (48.0%) (p = 0.001) but was not statistically different between the UEMR-SIM and CEMR groups (76.8%) (p = 0.209).

Conclusions

Our study indicates that the proposed method, UEMR-SIM for SNADETs, is feasible to achieve a high R0 resection rate and a potentially low local recurrence rate.

Keywords:

• Duodenal neoplasms
• underwater endoscopic mucosal resection
• marking
• submucosal injection
• tumor-free margins

Acknowledgements

The authors thank Editage (www.editage.com) for English language editing. The authors would thank Yurika Kawazoe and Shuntaro Sato for their beneficial advice on statistical analysis.

Ethical approval

This study was reviewed and approved by the Institutional Review Board of Nagasaki University Hospital (approval number: 22051606). The study was conducted in accordance with the ethical guidelines laid down by the Declaration of Helsinki (as revised in Fortaleza, Brazil; October 2013). Written informed consent was obtained from all patients included in the study.

Author contributions

All authors were involved in the study interpretation and contributed to the completion of this study. KH contributed to the study conception and design, manuscript writing, data analysis, performance of procedures, and critical revision of the article for important intellectual content; NY and K Ohnita contributed to the study conception and design, performance of procedures, and literature search; JS, TA, K Ogihara, MT, and MK contributed to the performance of procedures, data acquisition, and analysis; KM contributed to data interpretation and draft creation; YA contributed to the study conception and design, pathological diagnoses, and draft creation; and KN contributed to the study conception and design, and critical revision of the article for important intellectual content.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The datasets generated and analyzed during the study are included in this manuscript. Further inquiries can be directed to the corresponding author.

Additional information

Funding

No funding was received for this study.