Nomoto Yoshie, Shinozaki Satoshi, Miura Yoshimasa, Osawa Hiroyuki, Ino Yuji, Yano Tomonori, Lazaridis Nikolaos, Yamamoto Hironori
Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
Shinozaki Medical Clinic, Utsunomiya, Japan.
Clin Endosc. 2025 Jul;58(4):561-568. doi: 10.5946/ce.2024.181. Epub 2025 Mar 12.
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).
This retrospective observational study included patients who underwent UEMR for SNADETs.
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.
The UEMR-A technique for SNADETs appears to improve R0 resection rates and reduce procedure times compared to the UEMR-C technique.
水下内镜黏膜切除术（UEMR）是浅表非壶腹十二指肠肿瘤（SNADETs）的标准切除方法。我们开发了一种新型的UEMR技术，通过注射生理盐水使远端皱襞突出以形成一个锚定物（UEMR-A）。本研究的目的是阐明UEMR-A与传统UEMR（UEMR-C）相比的有效性。
这项回顾性观察研究纳入了因SNADETs接受UEMR的患者。
总共纳入141例患者，并分为UEMR-A组（n = 54）和UEMR-C组（n = 87）。与UEMR-A组相比，UEMR-C组中由专家内镜医师进行病变切除的频率显著更高（p<0.001）。尽管黏膜下注射需要额外时间，但UEMR-A的操作时间显著短于UEMR-C（p = 0.018）。UEMR-A组的R0切除率显著高于UEMR-C组（p = 0.004）。UEMR-A组的水平切缘比UEMR-C组明显更清晰（p = 0.018）。多因素分析显示，使用UEMR-A是R0切除的唯一显著正性因素。
与UEMR-C技术相比，用于SNADETs的UEMR-A技术似乎提高了R0切除率并缩短了操作时间。
