• Dong Hyun Kim, Seon-Young Park, Eunae Cho, Chang Hwan Park, Hyun Soo Kim, Sung Kyu Choi, and Jong Sun Rew.
• Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, South Korea.
• Medicine (Baltimore). 2021 Jan 15; 100 (2): e24041e24041.

RationaleEndoscopic resection of superficial non-ampullary duodenal epithelial neoplasm (SNADEN) is a challenging procedure owing to the high recurrence rate and considerable incidence rate of adverse events.Patient ConcernsSNADEN accidentally found during a medical examination in a 56-year-old man.DiagnosisThe patient was diagnosed as having a 20-mm-sized flat elevated SNADEN at the superior duodenal angle.InterventionsFirst, we tried to perform conventional EMR (CEMR). However, the submucosal injection interrupted the endoscopic view and did not provide enough space for CEMR because of its angulated location. Therefore, we chose to perform endoscopic resection using the "loop-and-let-go" technique. Follow-up duodenoscopy after 2 days revealed post CEMR ulcer with suspicious remnant lesion. Underwater endoscopic mucosal resection (UEMR) was successfully performed 3 months after the first session of endoscopic resection.OutcomesComplete endoscopic en bloc resection and histological complete resection were achieved with UEMR. Follow-up duodenoscopy revealed no recurrence.LessonsStep-by-step endoscopic treatment with UEMR following loop-and-let-go technique may be a good strategy for SNADEN over 20-mm in diameter.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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