Horii Toshiki, Harada Yohei, Kitahara Gen, Wada Takuya, Watanabe Akinori, Ishido Kenji, Ikehara Hisatomo, Kusano Chika
Department of Gastroenterology Kitasato University of Medicine Kanagawa Japan.
Department of Pathology Kitasato University of Medicine Kanagawa Japan.
DEN Open. 2025 Mar 19;5(1):e70091. doi: 10.1002/deo2.70091. eCollection 2025 Apr.
There is concern that underwater endoscopic mucosal resection (UWEMR) uses buoyancy to elevate the lesion for snare resection, resulting in a shallower resection depth than that in endoscopic mucosal resection (EMR). We aimed to compare conventional EMR and UWEMR in terms of resection depth.
We retrospectively reviewed cases in which EMR or UWEMR was performed for superficial non-ampullary duodenal epithelial tumors of ≤20 mm between April 2018 and February 2024. The endpoints were histological complete resection rate, en bloc resection rate, presence of muscularis mucosa and submucosa in the resection specimen, and submucosal index calculated from the resection specimen.
EMR was performed on 19 lesions and UWEMR was performed on 52 lesions. Histological complete and en bloc resection rates were not significantly different between EMR and UWEMR (57.9% and 63.5%, respectively, = 0.78; 78.9% and 90.4%, respectively, = 0.24). No significant differences were observed between EMR and UWEMR in the muscularis mucosa of the resected specimens (78.9% and 92.3%, respectively, = 0.20). The presence of submucosa in resected specimens was encountered less often in EMR cases than in UWEMR cases (57.9% versus [vs.] 84.6%, = 0.03). There were significant differences in the submucosal index in the resected specimens between EMR and UWEMR cases (median 0.15 [interquartile range 0-0.39] vs. 0.33 [0.17-0.57], = 0.04).
UWEMR potentially includes the submucosa within the specimen.
有人担心水下内镜黏膜切除术（UWEMR）利用浮力将病变抬起以进行圈套切除，导致切除深度比内镜黏膜切除术（EMR）浅。我们旨在比较传统EMR和UWEMR在切除深度方面的差异。
我们回顾性分析了2018年4月至2024年2月期间因直径≤20mm的浅表非壶腹十二指肠上皮肿瘤而接受EMR或UWEMR治疗的病例。观察终点为组织学完全切除率、整块切除率、切除标本中黏膜肌层和黏膜下层的存在情况以及根据切除标本计算的黏膜下指数。
对19个病变进行了EMR，对52个病变进行了UWEMR。EMR和UWEMR的组织学完全切除率和整块切除率无显著差异（分别为57.9%和63.5%，P = 0.78；分别为78.9%和90.4%，P = 0.24）。EMR和UWEMR切除标本的黏膜肌层情况无显著差异（分别为78.9%和92.3%，P = 0.20）。EMR病例切除标本中出现黏膜下层的情况比UWEMR病例少（57.9%对84.6%，P = 0.03）。EMR和UWEMR病例切除标本的黏膜下指数存在显著差异（中位数0.15[四分位间距0 - 0.39]对0.33[0.17 - 0.57]，P = 0.04）。
UWEMR有可能将黏膜下层纳入标本中。
