Clinical Endoscopy

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; Received July 4, 2024 Accepted September 30, 2024 Published online March 12, 2025; DOI: https://doi.org/10.5946/ce.2024.181 [Epub ahead of print]

Graphical Abstract Abstract PDF PubReader ePub: 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.

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Roles of Capsule Endoscopy and Balloon-Assisted Enteroscopy in the Optimal Management of Small Bowel Bleeding: Hani Abutalib, Tomonori Yano, Satoshi Shinozaki, Alan Kawarai Lefor, Hironori Yamamoto; Clin Endosc 2020;53(4):402-409. Published online July 30, 2020; DOI: https://doi.org/10.5946/ce.2020.143

The small bowel had long been considered a dark unapproachable tunnel until the invention of capsule endoscopy and doubleballoon enteroscopy in the 21st century, which revolutionized the diagnosis and management of small bowel diseases, including bleeding. Various imaging modalities such as computed tomographic enterography, angiography, capsule endoscopy, and balloonassisted enteroscopy play vital roles in the diagnosis and management of small bowel bleeding. The choice of modality to use and timing of application differ according to the availability of the modalities, patient’s history, and physician’s experience. Small bowel bleeding is managed using different strategies as exemplified by medical treatment, interventional radiology, endoscopic therapy, or surgical intervention. Balloon-assisted enteroscopy enables endoscopic interventions to control small bowel bleeding, including electrocautery, argon plasma coagulation, clip application, and tattooing as a prelude to surgery. In this article, we clarify the recent approaches to the optimal diagnosis and management of patients with small bowel bleeding.

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Double-Balloon Endoscopy-Assisted Balloon Dilation of Strictures Secondary to Small-Intestinal Lymphoma: Shogo Magome, Hirotsugu Sakamoto, Satoshi Shinozaki, Masahiro Okada, Tomonori Yano, Keijiro Sunada, Alan Kawarai Lefor, Hironori Yamamoto; Clin Endosc 2020;53(1):101-105. Published online July 10, 2019; DOI: https://doi.org/10.5946/ce.2019.015

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Akihiro Nakamura, Syuichi Komori, So Murai, Shiori Shibata, Hideyuki Oyama, Kazuhiro Kijima, Yoshikuni Harada, Gaku Kigawa, Takahiro Umemoto, Takafumi Ogawa, Kuniya Tanaka
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