Olympus reviewed the following literature "underwater endoscopic mucosal resection with submucosal injection and marking' for superficial non-ampullary duodenal epithelial tumors to achieve r0 resection: a single-center case series." abstract objectives: to describe an endoscopic technique named ¿underwater endoscopic mucosal resection (uemr) with submucosal injection and marking (uemr-sim)¿ and to evaluate the therapeutic characteristics of superficial non-ampullary duodenal epithelial tumors (snadets) < 20mm vis-a-vis classical emr (cemr) and uemr techniques.Materials and methods: this retrospective study included 103 consecutive snadet patients (103 lesions) who underwent cemr, uemr, or uemr-sim.The uemr-sim procedure included (1) marking and submucosal injection, (2) filling of the duodenal lumen with 0.9% saline, (3) snaring of the lesion, and (4) electrosurgical removal.The procedural outcomes were compared between the uemr-sim and other-procedure groups.Results: the en bloc resection rate was significantly higher in the uemr-sim group (100%) than in the cemr group (76.8%) (p.0.015) but was not statistically different between the uemr-sim and uemr groups (88.0%) (p.0.236).The r0 resection rate was significantly higher in the uemr-sim group (90.9%) than in the uemr group (48.0%) (p.0.001) but was not statistically different between the uemr-sim and cemr groups (76.8%) (p.0.209).¿type of adverse events/number of patients¿ delayed bleeding (1) the delayed-bleeding case was an 8-mm flat lesion in the second portion of the duodenum in a 70-year-old man who had been taking warfarin due to atrial fibrillation.Cemr was performed with continued warfarin therapy, and the mucosal defect was completely closed.However, delayed bleeding occurred 3 and 6 days post-cemr, requiring endoscopic hemostasis twice and hospitalization for 18 days.Only one case showed a local recurrence after 32.4 months in the cemr group, whereas no local recurrences were observed in the uemr and uemr-sim groups.The local recurrence was successfully treated with salvage endoscopic mucosal dissection (esd).
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This report is being supplemented to provide additional information based on the legal manufacturer's final investigation.The device history record was unable to be reviewed for this device since the serial and/or lot number was not provided.However, olympus only releases products to market that meet all manufacturing specifications and final product release criteria.Based on the results of the investigation, the relationship between the device and the adverse events cannot be confirmed.There was no complaint reported on the subject device.There is no evidence of an olympus device malfunction.Therefore, the root cause cannot be determined.Olympus will continue to monitor field performance for this device.
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