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Suwa et al. Mini-invasive Surg 2022;6:20 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2021.123

Review Open Access

Cold snare polypectomy and underwater endoscopic

mucosal resection for superficial nonampullary
duodenal epithelial tumors

1
Tetsuya Suwa , Kohei Takizawa 2
1
Division of Endoscopy, Shizuoka Cancer Center, Shizuoka 411-8777, Japan.
2
Department of Gastroenterology and Endoscopy, Sapporo Kinentou Hospital, Hokkaido 004-0004, Japan.
Correspondence to: Prof. Kohei Takizawa, Department of Gastroenterology and Endoscopy, Sapporo Kinentou Hospital, 3-3-6
Atsubetsuhigashi 4-jo, Atsubetsu-ku, Sapporo, Hokkaido 004-0004, Japan. E-mail: koh.takizawa@gmail.com
How to cite this article: Suwa T, Takizawa K. Cold snare polypectomy and underwater endoscopic mucosal resection for
superficial nonampullary duodenal epithelial tumors. Mini-invasive Surg 2022;6:20. https://dx.doi.org/10.20517/2574-
1225.2021.123

Received: 29 Oct 2021 First Decision: 7 Feb 2021 Revised: 17 Feb 2022 Accepted: 25 Feb 202 Published: 22 Apr 2022

Academic Editor: Giulio Belli, Shinji Tanaka Copy Editor: Jia-Xin Zhang Production Editor: Jia-Xin Zhang

Abstract
Although the diagnostic and therapeutic opportunities for superficial nonampullary duodenal epithelial tumors
(SNADETs) have been increasing, the natural history and treatment outcomes remain unclear. Due to the
anatomical characteristics of the duodenum, clinicians should be more sensitive to the occurrence of complications
for tumors in the duodenum compared to other gastrointestinal tumors. Recently, with the expectation of minimally
invasive treatment, cold snare polypectomy (CSP) and underwater endoscopic mucosal resection (UEMR) have
been accepted as simple and safe endoscopic treatments for SNADETs. In our institution, CSP achieved good
treatment outcomes: a median procedure time of 3 (range, 1-23) min, an en bloc resection rate of 96.9%, an R0
resection rate of 50.0%, and a low incidence of adverse events (no delayed bleeding and no intra- and
postoperative perforation). Moreover, UEMR also achieved good treatment outcomes: a median procedure time of
5 (range, 1-104) min, an en bloc resection rate of 82.9%, an R0 resection rate of 52.0%, and a low incidence of
adverse events (delayed bleeding occurred in 2.6% of cases, and there were no incidences of no intra- and
postoperative perforation). Residual recurrences occurred in two lesions (4.1%) that were treated with CSP and
three lesions (4.8%) that were treated with UEMR, but these recurrences could be treated by re-endoscopic
resection. Although there are limited data on these treatments for SNADETs, some previous reports and our data
suggest that CSP could be indicated for adenomas sized 10 mm or less and that UEMR could be indicated for
adenomas sized 10-20 mm and for intramucosal carcinomas. However, at present, the number of cases evaluated
is still insufficient, and further studies are needed to evaluate long-term outcomes with enough cases.

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
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