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 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.
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