Editor’s Choice- Glenn Eisen

Editor-in-Chief, Glenn Eisen, MD, MPH, recommends the article “’Underwater’ EMR of sporadic laterally spreading nonampullary duodenal adenomas (with video)” by Kenneth F. Binmoeller, MD, Janak N. Shah, MD, Yasser M. Bhat, MD, and Steve D. Kane, BS from the September issue.

Dr. Binmoeller and colleagues have evaluated a novel technique of “underwater” EMR without prior submucosal injection for the removal of large laterally spreading nonampullary duodenal adenomas. Technical success was achieved in 11 of 12 patients, and completeness of resection was achieved in all 12.

Figure 1Figure 1. Endoscopic (A) and US (B) images showing underwater EUS when using a 12-MHz catheter US probe (miniprobe). The duodenal muscularis propria layers remain circular (arrows) and do not follow the involutions of the mucosa and submucosa.

This study successfully addresses some of the technical challenges involved with treating lesions larger than 2cm with EMR.

Underwater EMR has a high success rate for the resection of large, laterally spreading duodenal adenomas without submucosal injection, but the risk of delayed bleeding is significant and precautions are needed to avoid aspiration and water intoxification when infusing a large volume of fluid into the GI tract.

Read the article abstract here.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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