This study was a single-center, retrospective study. Inclusion criteria were patients with a preoperative diagnosis of SNADETs by M-NBI who underwent ER between December 2008 and November 2017 at Ishikawa Prefectural Central Hospital. Patients were excluded if they met the following exclusion criteria: (1) no recorded M-NBI images of the lesion in the image filing system; (2) morphological findings at M-NBI of the lesion were obscured by adherent mucous or hemorrhage associated with flushing; (3) evidence of familial adenomatous polyposis; or (4) pedunculated lesions, because we reported that it is difficult to diagnose pedunculated lesions by M-NBI 19 .

We retrospectively analyzed both the M-NBI images and histopathological findings of the consecutive resected SNADET specimens, which we classified into two categories: a non-biopsy group in which biopsy was not performed before M-NBI examination and a biopsy group in which biopsy was performed before M-NBI examination. We investigated the correlation between the characteristic microvascular and microsurface findings at M-NBI and the histopathological diagnosis of the SNADETs in both groups.

All endoscopic examinations were performed using high-resolution endoscopes with M-NBI in our hospital. Therefore, SNADETs were diagnosed by M-NBI and removed without biopsies. However, a minimal number of preoperative biopsies were required for protruded lesions in the duodenal bulb that were difficult to differentiate from non-neoplasms by M-NBI alone, such as gastric metaplasia, ectopic gastric mucosa, and Brunner’s gland hyperplasia.

We performed this retrospective study at our hospital in Japan. The institutional review board of our hospital approved the collection of data, examination of past cases, and submission of the results in this study (approval no. 1286), and written informed consent was obtained from all patients.

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