TECHNICAL TIPS FOR ENDOSCOPIC RESECTION USING A BIPOLAR SNARE FOR DUODENAL TUMORS

Abstract

The duodenum is thought to be the most challenging location in the gastrointestinal tract in which to perform endoscopic treatments. Although endoscopic submucosal dissection (ESD) is now widely performed in Japan and our facility was one of the pioneers in the development of ESD, we believe that ESD should not be aggressively performed in the duodenum. For lesions in the duodenum, we mainly select endoscopic mucosal resection (EMR) using a bipolar snare in which high-frequency current flows only in the snare and the tip of the sheath, so that there is almost no cauterization or tissue damage to the muscle layer. Different from the monopolar snare, when using the bipolar snare, the endoscopist should resect the lesion very slowly over 5-10 seconds after squeezing the snare. The greatest benefit of EMR using the bipolar snare is the low rate of delayed bleeding. As an endoscopic procedure, it is technically similar to EMR using a monopolar snare, except for the snare type and settings of the high-frequency generator. Safer endoscopic treatment in the duodenum is possible with the bipolar snare because the risk of delayed bleeding is extremely low. We believe that this procedure can be performed at many facilities.