Removing Duodenal Epithelial Lesions: Does Underwater Endoscopic Resection Work?
Vanessa M. Shami, MD, FASGE, reviewing Okimoto K, et al. Gastrointest Endosc 2021 Jul 17.
Underwater endoscopic mucosal resection (UEMR) has been increasingly utilized in the resection of colonic and duodenal mucosal lesions. Its use for resection of nonpolypoid superficial nonampullary duodenal epithelial tumors (SNADETs) has not been studied extensively. This retrospective study aimed to validate the efficacy of UEMR versus conventional EMR and cap-assisted EMR (EMRC) for SNADETs ≤20 mm in size.
Researchers analyzed data from consecutive patients who underwent resection of nonpolypoid SNADETs measuring ≤20 mm at Chiba University between May 2004 and October 2020. Twenty-one patients with 23 SNADETs underwent EMR, 60 patients with 61 SNADETs underwent UEMR, and 45 patients with 48 SNADETs underwent EMRC. Outcomes were analyzed using weighted logistic regression analysis. Univariate and multivariate logistic regression models were used to identify the predictors of indeterminate or positive tumor margins (RX/1) and piecemeal resection. Patient follow-up was at least 12 months.
R0 resection was significantly higher using UEMR and EMRC (vs EMR) (50.8%, 68.8%, vs 34.8%, respectively). UEMR had higher en bloc resection and lower postresection bleeding rates than EMR. One patient (2.1%) who underwent EMRC experienced intraoperative and postoperative perforation. The recurrence rates of EMR, UEMR, and EMRC were 4.3%, 2.0%, and 6.3%, respectively.
COMMENTEndoscopists can add UEMR to their armamentarium of tools for resecting duodenal lesions measuring ≤20 mm. Although this study suggests that UEMR may be at least comparable to EMR in R0 resection and bleeding, a randomized controlled trial is needed to assess the superiority of one technique over the other.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Okimoto K, Maruoka D, Matsumura T, et al. The utility of underwater endoscopic mucosal resection for nonpolypoid superficial nonampullary duodenal epithelial tumors <20mm. Gastrointest Endosc 2021 Jul 17. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2021.07.011)
