{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T17:31:55Z","timestamp":1781026315202,"version":"3.54.1"},"reference-count":20,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,3,19]],"date-time":"2025-03-19T00:00:00Z","timestamp":1742342400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["DEN Open"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>There is concern that underwater endoscopic mucosal resection (UWEMR) uses buoyancy to elevate the lesion for snare resection, resulting in a shallower resection depth than that in endoscopic mucosal resection (EMR). We aimed to compare conventional EMR and UWEMR in terms of resection depth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively reviewed cases in which EMR or UWEMR was performed for superficial non\u2010ampullary duodenal epithelial tumors of\u00a0\u226420\u00a0mm between April 2018 and February 2024. The endpoints were histological complete resection rate, en bloc resection rate, presence of muscularis mucosa and submucosa in the resection specimen, and submucosal index calculated from the resection specimen.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>EMR was performed on 19 lesions and UWEMR was performed on 52 lesions. Histological complete and en bloc resection rates were not significantly different between EMR and UWEMR (57.9% and 63.5%, respectively, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.78; 78.9% and 90.4%, respectively, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.24). No significant differences were observed between EMR and UWEMR in the muscularis mucosa of the resected specimens (78.9% and 92.3%, respectively, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.20). The presence of submucosa in resected specimens was encountered less often in EMR cases than in UWEMR cases (57.9% versus [vs.] 84.6%, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.03). There were significant differences in the submucosal index in the resected specimens between EMR and UWEMR cases (median 0.15 [interquartile range 0\u20130.39] vs. 0.33 [0.17\u20130.57], <jats:italic>p<\/jats:italic>\u00a0=\u00a00.04).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>UWEMR potentially includes the submucosa within the specimen.<\/jats:p><\/jats:sec>","DOI":"10.1002\/deo2.70091","type":"journal-article","created":{"date-parts":[[2025,3,19]],"date-time":"2025-03-19T07:56:02Z","timestamp":1742370962000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Comparison of the resection depth between endoscopic mucosal resection and underwater endoscopic mucosal resection for superficial non\u2010ampullary duodenal epithelial tumors: A retrospective study"],"prefix":"10.1002","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2808-2434","authenticated-orcid":false,"given":"Toshiki","family":"Horii","sequence":"first","affiliation":[{"name":"Department of Gastroenterology Kitasato University of Medicine  Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yohei","family":"Harada","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Kitasato University of Medicine  Kanagawa Japan"},{"name":"Department of Pathology Kitasato University of Medicine  Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1453-0125","authenticated-orcid":false,"given":"Gen","family":"Kitahara","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Kitasato University of Medicine  Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takuya","family":"Wada","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Kitasato University of Medicine  Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akinori","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Kitasato University of Medicine  Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6434-2902","authenticated-orcid":false,"given":"Kenji","family":"Ishido","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Kitasato University of Medicine  Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hisatomo","family":"Ikehara","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Kitasato University of Medicine  Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chika","family":"Kusano","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Kitasato University of Medicine  Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,3,19]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/den.13485"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2010.422"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2013.03.1330"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2021.07.011"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgh.15638"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/den.13184"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/den.12183"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000002634"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/bmt.2012.244"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-017-6044-7"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00535-020-01696-6"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1055\/a-1785-8616"},{"key":"e_1_2_11_14_1","volume-title":"Histology for Pathologists","author":"Mills SE","year":"2007"},{"key":"e_1_2_11_15_1","volume-title":"Gastrointestinal Pathology","author":"Fenoglio\u2010Preiser CM","year":"2008"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/den.13524"},{"key":"e_1_2_11_17_1","first-page":"154","article-title":"Underwater endoscopic mucosal resection for superficial nonampullary duodenal adenomas","volume":"50","author":"Yamasaki Y","year":"2018","journal-title":"Endoscopy"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.5946\/ce.2020.147"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1080\/00365521.2020.1867896"},{"key":"e_1_2_11_20_1","first-page":"379","article-title":"Efficacy and safety of underwater endoscopic mucosal resection for superficial non\u2010ampullary duodenal epithelial tumors: A systematic review and meta\u2010analysis","volume":"33","author":"Bhogal N","year":"2020","journal-title":"Ann 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