CC BY-NC-ND 4.0 · Endoscopy 2022; 54(S 02): E844
DOI: 10.1055/a-1838-4030
E-Videos

Underwater endoscopic mucosal resection: the best solution for treating local recurrence of duodenal adenoma

Mariana Figueiredo
1   Gastroenterology and Endoscopy Unit, Pavillon L, Edouard Herriot Hospital, Lyon, France
,
Clara Yzet
1   Gastroenterology and Endoscopy Unit, Pavillon L, Edouard Herriot Hospital, Lyon, France
,
1   Gastroenterology and Endoscopy Unit, Pavillon L, Edouard Herriot Hospital, Lyon, France
,
Nicolas Benech
1   Gastroenterology and Endoscopy Unit, Pavillon L, Edouard Herriot Hospital, Lyon, France
,
Jérôme Rivory
1   Gastroenterology and Endoscopy Unit, Pavillon L, Edouard Herriot Hospital, Lyon, France
,
Mathieu Pioche
1   Gastroenterology and Endoscopy Unit, Pavillon L, Edouard Herriot Hospital, Lyon, France
2   Inserm U1032, Labtau, Lyon, France
› Author Affiliations

The prevalence of duodenal adenomas ranges from 0.10 % to 0.82 % [1] [2]. Studies show that underwater endoscopic mucosal resection (EMR) is an efficient technique for the treatment of these kinds of lesions, with 87.5 % to 100 % complete endoscopic resection [3]. However, its use for the treatment of local recurrence after previous duodenal adenoma resection is yet to be well established.

We report the case of an 80-year-old woman who presented with a recurrent non-ampullary duodenal adenoma, initially resected by piecemeal EMR (low grade dysplasia) and hybrid EMR for a first recurrence (at 6 months). At follow-up endoscopy (2 years later), a new local recurrence was observed and underwater EMR was performed ([Video 1]). After filling the duodenal lumen with water, the 4-mm lesion floated up into the snare and was easily grasped and completely cut. The resection was macroscopically complete and there were no complications observed.

Video 1 Underwater endoscopic mucosal resection: the best solution for treating local recurrence of duodenal adenoma.


Quality:

To our knowledge, the role of underwater EMR is yet to be clearly established in the context of recurrent non-ampullary duodenal adenoma. Overall, this technique seems promising for increasing the rate of complete resections, potentially leading to lower recurrence rates. Nevertheless, strong evidence supporting its use in the context of recurrent duodenal adenomas is still lacking and further studies are necessary to fully confirm our hypothesis.

Endoscopy_UCTN_Code_CPL_1AH_2AZ

Endoscopy E-Videos
https://eref.thieme.de/e-videos

Endoscopy E-Videos is an open access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high quality video and all contributions are freely accessible online. Processing charges apply (currently EUR 375), discounts and wavers acc. to HINARI are available.

This section has its own submission
website at
https://mc.manuscriptcentral.com/e-videos



Publication History

Article published online:
25 May 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany