Clin Endosc > Epub ahead of print
Efficacy of Underwater Endoscopic Mucosal Resection for Superficial Non-Ampullary Duodenal Epithelial Tumor
Masanori Furukawa1 , Akira Mitoro2 , Takahiro Ozutumi2 , Yukihisa Fujinaga2 , Keisuke Nakanishi2 , Koh Kitagawa2 , Soichiro Saikawa2 , Sinya Sato2 , Yasuhiko Sawada2 , Hiroaki Takaya2 , Kosuke Kaji2 , Hideto Kawaratani2 , Tadashi Namisaki2 , Kei Moriya2 , Takemi Akahane2 , Junichi Yamao1 , Hitoshi Yoshiji2
1Division of Endoscopy, Nara Medical University Hospital, Nara, Japan
2Department of Gastroenterology, Nara Medical University, Nara, Japan
Correspondence :  Masanori Furukawa ,Tel: +81-744-22-3051, Fax: +81-744-21-7152, Email:
Received: June 3, 2020  Revised: August 30, 2020   Accepted: September 7, 2020

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.
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.
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.
UEMR is a feasible therapeutic option for SNADETs. It can be recommended as a standard treatment.
Key Words: Duodenal epithelial tumor; Endoscopic resection; Superficial non-ampullary duodenal epithelial tumor; Underwater endoscopic mucosal resection
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