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INTRODUCTION: Underwater endoscopic mucosal resection (UEMR) and cold snare polypectomy (CSP) are novel endoscopic procedures for superficial nonampullary duodenal epithelial tumors (SNADET). However, consensus on how to use both procedures appropriately has not been established. In this study, we evaluated treatment outcomes of both procedures, including resectability. METHODS: In this single-center randomized controlled study conducted between January 2020 and June 2022, patients with SNADET £12 mm were randomly allocated to UEMR and CSP groups. The primary end point was sufficient vertical R0 resection (SVR0), which was defined as R0 resection including a sufficient submucosal layer. We compared treatment outcomes including SVR0 rate between groups. RESULTS: The SVR0 rate was significantly higher in theUEMRgroup than in the CSP group (65.6% vs 41.5%, P5 0.01). By contrast, theR0resection rate was not significantly different between study groups (70.3% vs 61.5%, P50.29). The submucosal layer thickness was significantly greater in theUEMR group than in the CSP group (median 546 [range, 309--833] mm vs 69 [0--295] mm, P < 0.01). CSP had a shorter total procedure time (median 12 [range, 8--16] min vs 1 [1--3] min, P < 0.01) and fewer total bleeding events (9.4% vs 1.5%, P 5 0.06). DISCUSSION: UEMR has superior vertical resectability compared with CSP, but CSP has a shorter procedure time and fewer bleeding events. Although CSP is preferable for most small SNADET, UEMR should be selected for lesions that cannot be definitively diagnosed as mucosal low-grade neoplasias. [ABSTRACT FROM AUTHOR]

The article discusses a randomized control trial comparing underwater endoscopic mucosal resection (UEMR) with routine cold snare polypectomy (CSP) for the treatment of superficial nonampullary duodenal epithelial tumors. The authors raise questions about the procedure, including how water stays in the duodenum, how the involvement of the muscularis propria is excluded, and how the authors manage the incidence of bleeding. They also mention that UEMR marking techniques may vary. The authors of the original study respond to these questions and clarify the analysis methods used in their study. [Extracted from the article]