TIPS ON PERFORMING DUODENAL ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) USING A SCISSOR-TYPE KNIFE INCLUDING TIPS ON CLOSING A POST-ESD ULCER

Abstract

Superficial non-ampullary duodenal epithelial tumors (SNADETs) were previously reported to be rare. However, the detection rate of SNADETs has been increasing because of recent endoscopic advances. Endoscopic resection is the standard treatment for duodenal intramucosal neoplasms due to the low risk of lymph node metastasis. Endoscopic submucosal dissection (ESD) is associated with a higher complete resection rate and a lower recurrence rate for SNADETs of more than 20 mm in size than endoscopic mucosal resection (EMR). However, duodenal ESD is associated with a high incidence of adverse events (perioperative perforation, delayed bleeding, and delayed perforation) because it is technically difficult due to the anatomical features of the duodenum. Therefore, ESD for SNADETs remains controversial.

In this paper, we reveal tips on performing a safe and reliable ESD procedure using a scissor-type knife including methods of prophylactic closing of post-ESD ulcers.