"Tip-in underwater endoscopic mucosal resection" without submucosal injection for superficial nonampullary duodenal adenomas

Underwater endoscopic mucosal resection (EMR) has been reported as an effective treatment for superficial nonampullary duodenal adenomas [1] [2]. However, the en bloc and R0 resection rates have been relatively low [3], possibly because the floating center of the lesion can hinder the visualization of its distal edge. This can cause the snare tip to slip, making it difficult to capture the lesion and achieve en bloc resection. To overcome these challenges, we report our new technique of “tip-in underwater EMR” for superficial nonampullary duodenal adenomas.