A method of “Noninjecting Resection using Bipolar Soft coagulation mode; NIRBS” for superficial non-ampullary duodenal epithelial tumor: A pilot study

Background: Complete endoscopic resection of superficial non-ampullary duodenal epithelial tumors (SNADETs) is technically challenging, especially with an extremely high risk of adverse event (AE), although various endoscopic resection methods including endoscopic mucosal resection (EMR), underwater EMR (UEMR), and endoscopic submucosal dissection (ESD) have been tried for SNADETs. Hence, a novel simple resection method that can completely resect tumors with a low risk of AEs should be developed. Aims: A resection method of Noninjecting Resection using Bipolar Soft coagulation mode (NIRBS) which has been reported to be effective and safe for colorectal lesions is adapted for SNADETs. In this study we evaluated its effectiveness, safety, and simplicity for SNADETs measuring ≤20 mm. Results : This study included 13 patients with resected lesions with a mean size of 7.8 (range: 3–15) mm. The pathological distributions of the lesions were as follows: adenomas, 77% (n = 10) and benign and non-adenomatous lesions, 23% (n = 3). The en bloc and R0 resection rate was 100% (n = 13). The median procedure duration was 68 sec (32–105). None of the patients presented with major AEs including bleeding and perforation. Conclusions : NIRBSs for SNADETs measuring ≤20 mm may be a method to resect SNADETs efficiently, safely, and in a short procedure duration.