Future directions of duodenal endoscopic submucosal dissection

Figure 1 Endoscopic submucosal dissection of a neuroendocrine tumors in the superior duodenal bulb. A: A protruded-type tumor 0.9 cm × 0.9 cm in size was identified; B: We performed a submucosal dissection. The tip of a knife is perpendicularly oriented to the dissection surface.

Figure 2 Endoscopic submucosal dissection of an adenoma in the descending part of the duodenum. A: A depressed type tumor 1.2 cm × 1.2 cm in size was identified; B: After incising the oral side of the lesion, we slightly detached it to form a mucosal flap; C: A severe submucosal fibrosis was found.

Figure 3 Endoscopic submucosal dissection of an adenoma in the anterior duodenal bulb. A: A flat-elevated type tumor 6.0 cm × 5.0 cm in size was identified; B: We performed submucosal dissection using the ST hood.