Anchoring the snare tip using a small incision in the submucosa facilitates en bloc endoscopic mucosal resection for sporadic duodenal adenomas.

Sporadic duodenal adenomas are rare with an estimated prevalence of 0.31%– 4.6% on upper gastrointestinal endoscopy [1]. Nowadays, endoscopic resection is the recommended treatment for sporadic duodenal adenomas thanks to its low morbidity and mortality when compared with surgical duodenopancreatectomy [2]. The reference technique of endoscopic resection is endoscopic mucosal resection (EMR) with snare [3] because of the high risk of perforation associated with endoscopic submucosal dissection (ESD) [4]. The rate of en bloc resection with free margins using EMR is lower than that with ESD, resulting in a higher risk of local recurrence. Nevertheless, it is commonly accepted practice to use EMR, despite its lower rate of curative resection, in order to reduce the perforation rate. As previously demonstrated in the colon [5], snare-tip anchoring is effective at improving snare positioning and allows for an increase in the size of the resected area. This strategy could increase the rate of R0 resection compared with standard EMR. We report here two cases where EMR was used to treat duodenal adenomas in the second part of the duodenum of two septuagenarian patients. After saline solution had been injected into the submucosa, we anchored the tip of a 25-mm snare on one side of the adenoma ▶ Fig. 1 Endoscopic images of the procedure for duodenal endoscopic mucosal resection with snare-tip anchoring showing: a the injection of saline; b anchoring of the snare tip; c the snare being opened around the lesion; d the resected area. E-Videos