Underwater Endoscopic Mucosal Resection of Large Duodenal Adenomas (Video)

Abstract

Background and aims

Endoscopic mucosal resection (EMR) is a well-established method for the removal of neoplastic polyps throughout the GI tract. EMR typically involves insufflation of the lumen using air or CO₂, followed by submucosal lifting of a polyp to minimize the risk of deep tissue injury and perforation, followed by hot-snare polypectomy. Underwater endoscopic mucosal resection (UEMR) is a new technique that uses water to enable lesion visualization in a lumen that is not distended by air or CO₂, followed by piecemeal hot-snare resection of large mucosally-based neoplasms. UEMR does not require submucosal injection to create a fluid cushion. Very few published examples of UMER in the duodenum exist. This video case series describes the use of UEMR for the resection of several large duodenal adenomas.

Procedure

Underwater endoscopic mucosal resection was utilized for the removal of several large duodenal adenomas.

Results

Three duodenal lesions ranging from 1.8 cm to 5 cm were successfully resected by UEMR. The mean time for resection was 18 min. There were no adverse events.

Conclusions

UEMR is an efficacious technique for the resection of large mucosally-based neoplasms of the duodenum.