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Under-gel Endoscopic Mucosal Resection without Injection: A Novel Endoscopic Treatment Method for Superficial Nonampullary Duodenal Epithelial Tumors

ABSTRACT:

SUBMITTER: Amino H

PROVIDER: S-EPMC8580686 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Gel immersion endoscopy-facilitated endoscopic mucosal resection of a superficial nonampullary duodenal epithelial tumor: a novel approach.

Project description:Video 1Gel immersion endoscopy-facilitated endoscopic mucosal resection of a superficial nonampullary duodenal epithelial tumor.

| S-EPMC8431274 | biostudies-literature

Gel Immersion Endoscopic Mucosal Resection (EMR) for Superficial Nonampullary Duodenal Epithelial Tumors May Reduce Procedure Time Compared with Underwater EMR (with Video)

Project description:Materials and Methods This was a retrospective cohort study conducted in two municipal hospitals. We identified 24 patients with SNADETs of 3–18 mm in diameter who underwent UEMR or GIEMR. One lesion was excluded from the analysis because it was found to be in the stomach after surgery. The primary outcome was procedure time. Results GIEMR significantly reduced the procedure time compared with UEMR (5 min vs. 10 min, P = 0.016). There was no significant difference between the UEMR and GIEMR groups for en bloc resection rate (93% vs. 100%, P = 1.0) and R0 resection rate (57% vs. 80%, P = 0.39). No serious complications were observed in either group. Conclusions GIEMR of SNADET has the potential to reduce procedure time compared with UEMR and may be particularly effective in areas where immersion in water is difficult.

| S-EPMC9217606 | biostudies-literature

Efficacy and safety of underwater endoscopic mucosal resection for ≤20 mm superficial non-ampullary duodenal epithelial tumors: Systematic review and meta-analysis.

Project description:Background and aimsSuperficial non-ampullary duodenal epithelial tumors (SNADETs) as a rare disease have gradually increased in recent years. Underwater endoscopic mucosal resection (UEMR) has emerged as a newly available option for the endoscopic resection of SNADETs. This study aimed to evaluate the efficacy and safety of UEMR for ≤20 mm SNADETs.MethodsA literature search was performed across multiple databases, including PubMed, Embase, Scopus, and Clinical trials for studies containing tumors ≤20 mm published from January 1, 2012, to August 8, 2022. Outcomes examined were the pooled rates of en bloc resection, R0 resection, adverse events, and recurrence. Subgroup analyses of the resection rate were conducted stratified by sample size and polyp size.ResultsA total of 10 studies with UEMR performed in a total of 648 tumors were included for analysis. The pooled rate of en bloc resection and R0 resection was 88.2% (95% confidence interval (CI): 82.1-93.2) and 69.1% (95% CI: 62.2-76.1), respectively. The results showed pooled rate of intraoperative bleeding rate was 2.9% (95% CI: 0-9.0), delayed bleeding rate was 0.9% (95% CI: 0.1-2), recurrence rate was 1.5% (95% CI: 0-4.9). In the subgroup analysis, R0 and en-bloc resection rates were significantly higher in <10 mm than 10-20 mm SNADETs subgroups (R0 resection rate 83.1 vs. 48.6%; en bloc resection rate 100.0 vs. 84.0%, P < 0.05).ConclusionUnderwater endoscopic mucosal resection was an effective and safe technique for the optional treatment for ≤20 mm SNADETs, especially of <10 mm.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022340578.

| S-EPMC9853979 | biostudies-literature

Underwater Endoscopic Mucosal Resection without Submucosal Injection Facilitates En bloc Resection of Colon Adenomas Extending into a Diverticulum.

Project description:Superficial colonic neoplasms sometimes extend into a diverticulum. Conventional endoscopic mucosal resection of these lesions is considered challenging because colonic diverticula do not have a muscularis propria and are deeply inverted. Even if the solution is carefully injected below the mucosa at the bottom of the diverticulum, the mucosa is rarely elevated from the diverticular orifice, and it is usually just narrowed. Although endoscopic submucosal dissection or full-thickness resection with an over-the-scope clip device enables the complete resection of these lesions, it is still challenging, time consuming and expensive. Underwater endoscopic mucosal resection without submucosal injection (UEMR) is an innovative technique enabling en bloc resection of superficial colon lesions. We report three patients with colon adenomas extending into a diverticulum treated with successful UEMR. UEMR enabled rapid and safe en bloc resection of colon lesions extending into a diverticulum.

| S-EPMC8182237 | biostudies-literature

Current Challenge: Endoscopic Submucosal Dissection of Superficial Non-ampullary Duodenal Epithelial Tumors.

Project description:Opinion statementWith the widespread use of esophagogastroduodenoscopy in recent years, the detection rate of superficial non-ampullary duodenal epithelial tumors (SNADETs) is increasing. Most SNADETs are early-stage adenocarcinoma or benign conditions, including adenoma. Therefore, endoscopic resection is desirable from the perspective of quality of life. However, endoscopic resection for SNADETs has not yet been established. Endoscopic submucosal dissection (ESD) is the most promising method for the treatment of SNADETs, because ESD provides a high rate of en bloc resection and a low rate of recurrence regardless of the tumor size. However, the difficulty of the procedure and a high rate of severe adverse events including perforation and bleeding have become major problems. Various preventive countermeasures for adverse events, such as use of specific devices, endoscope stabilization methods, and endoscopic closure of the post-ESD ulcer using clips, are reported to reduce the risk of the adverse events of ESD for SNADETs. This article reviews and highlights the current state of ESD for SNADETs and new challenges towards safe and effective ESD.

| S-EPMC7588384 | biostudies-literature

Usefulness and safety of a scissors-type knife in endoscopic submucosal dissection for nonampullary duodenal epithelial tumors.

Project description: Not available

| S-EPMC6119203 | biostudies-literature

A case of duodenal polyp at superior duodenal angle successfully treated by cap-assisted endoscopic mucosal resection.

Project description: Not available

| S-EPMC7730507 | biostudies-literature

Underwater endoscopic mucosal resection of an incompletely resected superficial non-ampullary duodenal epithelial neoplasm using the loop-and-let-go technique: A case report.

Project description:RationaleEndoscopic resection of superficial non-ampullary duodenal epithelial neoplasm (SNADEN) is a challenging procedure owing to the high recurrence rate and considerable incidence rate of adverse events.Patient concernsSNADEN accidentally found during a medical examination in a 56-year-old man.DiagnosisThe patient was diagnosed as having a 20-mm-sized flat elevated SNADEN at the superior duodenal angle.InterventionsFirst, we tried to perform conventional EMR (CEMR). However, the submucosal injection interrupted the endoscopic view and did not provide enough space for CEMR because of its angulated location. Therefore, we chose to perform endoscopic resection using the "loop-and-let-go" technique. Follow-up duodenoscopy after 2 days revealed post CEMR ulcer with suspicious remnant lesion. Underwater endoscopic mucosal resection (UEMR) was successfully performed 3 months after the first session of endoscopic resection.OutcomesComplete endoscopic en bloc resection and histological complete resection were achieved with UEMR. Follow-up duodenoscopy revealed no recurrence.LessonsStep-by-step endoscopic treatment with UEMR following loop-and-let-go technique may be a good strategy for SNADEN over 20-mm in diameter.

| S-EPMC7808504 | biostudies-literature

A case of laparoscopy and endoscopy cooperative surgery for circumferential superficial nonampullary duodenal epithelial tumor.

Project description: Not available

| S-EPMC7650229 | biostudies-literature

Endoscopic hemostasis using gel immersion endoscopy for duodenal ulcer and a sigmoid colon polyp: A novel gel injection method.

Project description:Gel immersion endoscopy (GIE) has gained prominence for securing a good visual field. Traditionally, OS-1 jelly (Otsuka Pharmaceutical Factory) has been used for GIE. However, due to the presence of electrolytes, it is unsuitable for endoscopic hemostasis using a monopolar device. Therefore, VISCOCLEAR (Otsuka Pharmaceutical Factory), a new gel that does not contain electrolytes, has been developed. Moreover, unlike water or saline, VISCOCLEAR does not readily mix with blood, making it effective in visualizing gastrointestinal bleeding. We report two cases in which GIE was performed using a novel gel injection method.

| S-EPMC9667408 | biostudies-literature

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