Post written by Ding-Ek Toh, MD, from the Division of Gastroenterology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, and Chu-Kuang Chou, MD, from the Division of Gastroenterology and Hepatology, Department of Internal Medicine, and the Obesity Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan.

This video represents a novel method to resect a 20-mm duodenal subepithelial lesion endoscopically.

We first made a circumferential mucosal incision before partial submucosal dissection to expose the tumor. Then we used an independently controlled snare with adjustable traction capability to further explore the desirable dissection plane effectively.

This tumor was removed successfully, and the defect was closed with hemostatic clips. The patient resumed a diet 2 days later, and the postprocedural course was uneventful.

Resection of a duodenal subepithelial lesion is a challenging procedure, given the high risk of adverse events and incomplete removal. This snare-assisted traction method enables endoscopists to maintain adequate tension for effective cutting and keeping the lesion intraluminal during dissection.  

In comparison with the clip-and-thread traction method, the snare-assisted traction method provides multidirectional forceful traction to expose a favorable dissection plane more efficiently, offering the opportunity to expedite the whole resection process.

The tumor was located in the duodenal bulb.

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