Endoscopic resection in combination with ligation for the treatment of duodenal subepithelial lesions: a single-center experience

WITHDRAWN: Snare traction-assisted method during endoscopic resection for gastric submucosal tumors: a single center case series

BACKGROUND

Endoscopic resection (ER) of gastric submucosal tumors (G-SMTs) is challenging due to the difficulty of exposure. Traction-assisted ER has been shown to provide better outcomes than traditional endoscopic operation by exposing the dissection plane. In this study, we investigated the efficacy and safety of the snare traction-assisted method in ER of G-SMTs.

METHOD

From May 2021 to March 2023, we used snare traction-assisted method to treat 24 patients with 24 G-SMTs in our department. Clinical characteristics and the outcomes of ER were recorded.

RESULT

The mean tumor diameter was 1.8±0.9 cm. Six G-SMTs underwent endoscopic submucosal dissection (ESD), and 18 underwent endoscopic full-thickness resection (EFTR). En bloc resection and R0 resection was achieved in all the 24 lesions. The average procedure time was 45.4 ± 23.4 minutes. The patients were discharged in 5.0 days after procedures, without delayed bleeding or other adverse events.

CONCLUSION

Snare traction-assisted method provides an effective traction for endoscopic resection of G-SMTs even if the tumor is difficult to remove. While further studies comparing the snare traction-assisted method with the conventional procedure are necessary.

Endoscopic resection of a descending duodenal polyp with the string-clip traction

There is few studies about modified endoscopic treatment of duodenal lesions. The string-clip method is an effective option for large pedunculated duodenal polyp. On the one hand, it could increase the tension of the lesion and make endoscopic resection easy. What is more, with the help of clip and dental floss, we do not have to worry about specimen losing. We could deal with the wound first and then retrieve the resected specimen, resulting in an increased safety and efficiency of the endoscopic treatment.

A small transparent cap, an extensive use

A 92-year-old woman complained of dysphagia and vomit for 4 days without previous disease history. We use the transparent cap empty esophageal solid foods.

Successful endoscopic removal of a giant duodenal bulb mass

A 53-year-old man presented to our hospital for resection of a duodenal mass because of the increasing diameter. Esophagogastroduodenoscopy revealed a giant oval mass in the back wall of duodenal bulb, which was protruded to the second part of duodenum(Figure 1). Endoscopic ultrasonography (EUS) revealed a submucosal mass with heterogeneous echogenicity and regular shape(Figure 2). Eventually, the patient received endoscopic submucosal dissection (ESD) after signing informed consent. The mass was resected completely and measured 6.0×4.2×3.0 cm [Figure 3]. Histopathological examination revealed a brunner's gland adenoma. There was no complication besides minor intraoperative bleeding. Both surgery and endoscopic resection (ER) are alternative treatments for duodenal adenoma, but the best way remains controversial. Due to the thin wall, narrow cavity and plentiful vascular network of the duodenal bulb, ER is challenging because of the technical difficulty and probability of perforation and bleeding [1]. Our previous study found that ER is an effective and safe way for treating duodenal adenoma on experienced hands, and ER possesses several advantages over surgical resection for selected patients [2，3]. In the present case, we removed the giant BGA by ESD, as far as we know, this is the largest yet removed by ER.