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Suwa et al. Mini-invasive Surg 2022;6:20 https://dx.doi.org/10.20517/2574-1225.2021.123 Page 9 of 11

Table 3. Patient characteristics, procedural results (UEMR), and previous literature
Our report (UEMR) Yamasaki et al. [19] (UEMR)
(Patients/Lesions) (71/76) (155/166)
a b
Age, median (range) 70.5 (28-89) years 65.9 (±10.6) years
Sex (male/female), n 41/30 110/ 45
Location (1st/2nd/3rd), n 12/61/3 10/151/5
a b
Size (endoscopic), (range) 10 (2-40) mm 10.0 (±4.1) mm
Macroscopic type, n
(0-I/0-IIa/0-IIa+IIc/0-IIc) 10/37/21/8 18/106/0/42
Biopsy before UEMR 48.7% (37/76) 100% (166/166)
Closure after UEMR 94.7% (72/76) 99.4% (165/166)
En bloc resection 82.9% (63/76) 89.8% (149/166)
Histopathological assessment, n
(carcinoma/adenoma/nonneoplastic) 17/55/4 74/91/1
R0 resection 52.0% (39/75) 66.9% (111/166)
HMs negative 50.0% (36/72) -
VMs negative 97.2% (70/72) -
Adverse events, n
delayed bleeding/ 2/0/0 2/0/0
intraoperative perforation/delayed perforation
Recurrence 4.8% (3/52) c 2.6% (4/155) d
a b c
UEMR: Underwater endoscopic mucosal resection; HM: horizontal margin; VM: vertical margin; median (range); mean (±SD); carcinoma or
d
adenoma, a month after UEMR. The median follow-up period was 2 months (range, 1-37 months); 12 months after UEMR.
More cases for evaluation are needed to clarify the distinction between UEMR and other treatment
methods, such as EMR or ESD.

CONCLUSION
The indications and outcomes of CSP and UEMR as minimally invasive treatments for SNADETs are
outlined, and we present the results of previous reports, as well as our results. However, one of the most
important problems with SNADETs was the lower preoperative diagnostic accuracy including preoperative
biopsy [27-29] , and further research is needed to determine whether image enhancement endoscopy is
necessary and how to improve preoperative diagnostic quality. Recently, Japan and the ESGE [30,31] published
guidelines on the management of duodenal tumors, which provided certain directions for the treatment of
SNADETs. However, previous reports are few, and the number of cases is still insufficient; thus, further
evidence is desired in the future.

DECLARATIONS
Authors’ Contributions
Made substantial contributions to the conception and design of the study, performed data analysis and
interpretation, and performed data acquisition: Suwa T, Takizawa K

Availability of Data and Materials
Not applicable.

Financial Support and Sponsorship
None.