Reply to Drs. Liu and Yao

We thank Drs. Liu and Yao for their comments concerning our article “Outcomes of endoscopic resection for superficial duodenal tumors: 10 years’ experience in 18 Japanese high volume centers.” In this study, we analyzed the short-term outcomes of various kinds of endoscopic treatment, including conventional endoscopic mucosal resection (EMR), underwater EMR (UEMR), cold polypectomy, and endoscopic submucosal dissection (ESD); we reported preferable outcomes for these endoscopic treatments.

With regard to the first comment by Drs. Liu and Yao that our study results might be influenced by endoscopists’ skill levels, we agree with their opinion. As duodenal endoscopic treatment is generally considered technically very challenging and is associated with quite high risks of adverse events, it was performed mainly by expert endoscopists during the study period. Recently, the use of duodenal endoscopic treatment has been getting more widespread owing to improvements in treatment techniques and medical devices. Further prospective study is warranted to confirm the generalizability of these treatments.

We also agree that the location of the lesion would affect the maneuverability of the endoscope and therefore the outcomes. Notably, our study included not only UEMR but also various kinds of endoscopic treatment (including cold polypectomy, conventional EMR, and ESD), and therefore it is difficult to answer this query directly. Further large scale studies focused on UEMR are warranted.

Publication History

Article published online:
28 June 2023