Patients and target lesions
SNADETs detected via upper gastrointestinal endoscopy from September 2021 to May 2024 at Japan Community Healthcare Organization Hoshigaoka Medical Center, Osaka, Japan, were consecutively evaluated. The inclusion criteria were as follows: (1) patients endoscopically diagnosed with SNADETs (biopsy before treatment was not required); (2) those with lesions measuring ≤20 mm; (3) those with lesions located between the 1st and 3rd part of the duodenum, except those near the pyloric ring; (4) those aged ≥20 years; and (5) those who provided a written informed consent. The endoscopic diagnosis of SNADET was based on the white light imaging scoring system, as reported in a previous study24. Chromoendoscopy and narrow band imaging findings were also taken into consideration. The procedure was performed with the temporary discontinuation of antithrombotic therapy.
Procedures
NIRBS was defined as conditions meeting (1) – (5). (1) The XEMEX Bipolar Snare S (Zeon Medical Inc., Tokyo, Japan) was used. (2) The electrosurgery generator mode was set to the soft coagulation mode at 30 W and Effect 5 (VIO 300D, ERBE Elektromedizin GmbH Co., Ltd., Tubingen, Germany) or the soft coagulation mode at Effect 3.3 (VIO 3, ERBE Elektromedizin GmbH Co., Ltd., Tubingen, Germany). (3) Injection into the submucosal layer was not performed. (4) The lesion, including the surrounding normal mucosa, was grasped extensively due to snaring with sucking the air. (5) With continuous sufficient squeezing using the quick juggling technique23, each lesion was resected according to its respective energization, which was as follows: within 2, 5, and 10 sec for those measuring ≤5, 6–10, and >10 mm, respectively (Figure 1, 2). The quick juggling technique was continuously applied from energization to resection. The procedure was performed using GIF-H290T (Olympus Medical Systems Co., Ltd., Tokyo, Japan). After resection, clipping disclosure was performed using long clips (Olympus Medical Systems Co., Ltd.).
Study design
This single-center, retrospective study evaluated the use of NIRBSs for SNADETs. The primary endpoint was en bloc resection rate. The secondary endpoints were rate of AEs (perforation and bleeding) including delayed AEs and mean procedure duration.
Adverse events
Delayed bleeding was defined as clinical evidence of bleeding after the procedure, evidenced by hematemesis or melena requiring endoscopic treatment. Delayed perforation was defined as the presence of perforation not detected during and just after procedural completion, free air on radiography or computed tomography scan after the procedure, and perforation at the resection site on subsequent endoscopy. Delayed AEs were defined as AEs occurring within 1 month after the end of the procedure.
Procedure duration
Procedure duration was defined asthe time from snare insertion into the working channel of the scope to lesion resection.
Ethical statements
This study was conducted in accordance with the Declaration of Helsinki. It was approved by the Institutional Review Board and Ethics Committee of Japan Community Healthcare Organization Hoshigaoka Medical Center (registration date: 2023/12/19, approval number: 2374). All participation in this study was consented to by opt-out. It was also registered with the University Hospital Medical Information Network Clinical Trials Registry (registration date: 2023/12/20, number: UMIN 000053170).