| Featured Session 1 (JGES,JSGE,JSGS) |
| Fri. November 1st 9:00 - 11:00 Room 1: Kobe International Exhibition Hall No.2 Building Hall (North) |
| A case of 50mm laterally spreading ampullary tumor endoscopically resected together with both main and accessory papilla | |||
| Motohiko Kato1, Shintaro Kawasaki1 | |||
| 1Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine | |||
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| A 56-year-old male patient was referred for the treatment of ampullary tumor. EGD revealed a 50-mm large whitish flat elevated lesion involving main papilla. Accessory papilla was also seen very close to the anterior side of the lesion. MRCP showed no anatomic abnormality including pancreatic divisum. Based on these findings, we made a decision to perform ESD using water pressure method (WPM). First, a mucosal incision was made on the anal side, and then a circumferential incision was made. Although the accessory papilla was not involved in the lesion, it was too close to the lesion to keep secure lateral margin. The pancreatic duct at the part of accessory papilla was disconnected, and after dissecting the submucosa except for the papillary area, the bile duct and pancreatic duct were disconnected. Finally, the lesion was resected in a single piece without any complications. Subsequently ERCP was performed and a 5Fr ENBD tube and ENPD tube were placed. The clinical course was event free except mild pancreatitis and he discharged POD 7. The final pathological diagnosis was high-grade adenoma, 46 x 19 mm, and the resection margins were negative. Preoperative evaluation including bile duct and pancreatic duct anatomy, precise resection technique using WPM, and multidisciplinary perioperative management made it possible to safely perform endoscopic resection in a highly challenging case. |
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Index Term 1: ESD Index Term 2: Ampullary |
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