Table 2 Indication, advantages and disadvantages of each endoscopic treatment for superficial nonampullary duodenal epithelial tumors
From: Current endoscopic diagnosis treatment strategy for superficial nonampullary duodenal tumours
Method | Advantages | Disadvantages | Indications |
|---|---|---|---|
C-EMR | Moderate feasibility Moderate safety | Low en bloc resection rate with lesion > 20 mm | C3: > 10 mm C4/5: < 20 mm without submucosal invasive |
Cold snare polypectomy | Fast Simple Less thermal damage | Incomplete excision, Inaccurate excision margin | C3: < 10 mm |
Underwater EMR | Lower risk of perforation and safer than EMR | Low en bloc rate for lesions > 20 mm | C3: > 10 mm C4/5: < 20 mm without submucosal invasive |
ESD | High en bloc rate | High complication rate Technically challenging | C4/5: < 30 mm without submucosal invasive |
Modified ESD | |||
 The pocket-creation method | Less complication rate Better scope control during ESD | High cost | C4/5: < 30 mm without submucosal invasive |
 Water pressure method | Shortens procedure times | Special device | C4/5: < 30 mm without submucosal invasive |
Laparoscopic endoscopic collaborative surgery | High en bloc rate Less complication rate | Technically challenging High cost Lack of long-term data | C4/5: 20–40 mm and more than 10 mm from the papilla, without submucosal invasive |