Clinical Endoscopy

Original Article

Utility of underwater endoscopic mucosal resection combined with a protruding anchor by saline injection for superficial non-ampullary duodenal tumors: a retrospective study in Japan: Yoshie Nomoto, Satoshi Shinozaki, Yoshimasa Miura, Hiroyuki Osawa, Yuji Ino, Tomonori Yano, Nikolaos Lazaridis, Hironori Yamamoto; Clin Endosc 2025;58(4):561-568. Published online March 12, 2025; DOI: https://doi.org/10.5946/ce.2024.181

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Background
/Aims: Underwater endoscopic mucosal resection (UEMR) is the standard resection method for superficial non-ampullary duodenal tumors (SNADETs). We developed a novel UEMR technique that creates an anchor by protruding the distal fold with a saline injection (UEMR-A). The aim of this study was to clarify the usefulness of UEMR-A compared to conventional UEMR (UEMR-C).
Methods
This retrospective observational study included patients who underwent UEMR for SNADETs.
Results
A total of 141 patients were included and divided into UEMR-A (n=54) and UEMR-C (n=87) groups. Lesion resection was performed significantly more frequently by an expert endoscopist in the UEMR-C group compared to the UEMR-A group (p<0.001). The procedure time for UEMR-A was significantly shorter than that for UEMR-C (p=0.018), despite the additional time required for submucosal injection. The R0 resection rate was significantly higher in the UEMR-A group than in the UEMR-C group (p=0.004). The horizontal margins were significantly clearer in the UEMR-A group than in the UEMR-C group (p=0.018). Multivariate analysis revealed that the use of UEMR-A was the only significant positive factor for R0 resection.
Conclusions
The UEMR-A technique for SNADETs appears to improve R0 resection rates and reduce procedure times compared to the UEMR-C technique.

Citations

Citations to this article as recorded by

Advancement of endoscopic treatment in GI tract
Yoshimasa Miura
Journal of Nihon University Medical Association.2025; 84(3): 119. CrossRef
Evaluation of a modified underwater endoscopic mucosal resection technique for duodenal neoplasms: clinical implications and future directions
Ji Yong Ahn
Clinical Endoscopy.2025; 58(4): 544. CrossRef
Reply to the comments on ‘Utility of underwater endoscopic mucosal resection combined with a protruding anchor by saline injection for superficial non-ampullary duodenal tumors: a retrospective study in Japan'
Hironori Yamamoto, Yoshie Nomoto, Satoshi Shinozaki, Yoshimasa Miura, Hiroyuki Osawa
Clinical Endoscopy.2025; 58(6): 953. CrossRef
A reformative underwater endoscopic mucosal resection technique for superficial non-ampullary duodenal tumors
Yiheng Yao, Guolei Shi, Xingjie Shen, Liang Liu
Clinical Endoscopy.2025; 58(6): 951. CrossRef

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