| Featured Session 1 (JGES,JSGE,JSGS) |
| Fri. November 1st 9:00 - 11:00 Room 1: Kobe International Exhibition Hall No.2 Building Hall (North) |
| Noble ESD Technique for Duodenal Ampullary Tumors Under Mini-probe Ultrasonography Guidance | |||
| Yuki Nakajima1, Daiki Nemoto2, Kohei Suzuki1 | |||
| 1Department of Coloproctology and Gastroenterology, Fukushima Medical University Aizu Medical Center, 2Gastroenterology, Takeda General Hospital | |||
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| Background: ESD for ampullary tumors poses technical challenges. We previously reported a novel technique utilizing mini-probe ultrasonography (MPU) to localize the sphincter of Oddi (SO), aiding in precise dissection just above the muscularis propria (Endoscopy 2023, E92-93). Herein, we present our experience with four cases of ampullary ESD and their short-term outcomes. ESD Techniques: A mucosal incision was initiated proximal to the tumor, followed by the creation of submucosal pockets on both lateral sides of the ampulla. Mini-probe was then inserted into these pockets to visualize the SO and duodenal muscularis. The appropriate dissection line was determined based on MPU guidance. The SO was dissected from the muscularis using a scissor-type knife in Endocut I mode to minimize thermal damage to pancreaticobiliary ducts. En bloc resection was achieved, followed by placement of bile and pancreatic duct stents and closure of the mucosal defect using endoclips. Results: En bloc resection was successfully accomplished in all patients (2 mucosal cancers, 2 adenomas). The median procedure time was 140 minutes (range: 123-229 minutes). Intraoperative minor perforation occurred in one patient, which was promptly closed with clipping. Three patients had an uneventful postoperative course, while one experienced mild pancreatitis. The median hospital stay was 8 days (range: 7-9 days). Summary: In our series, ESD utilizing MPU guidance enhanced the rate of complete resection and safety profile. |
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Index Term 1: ESD Index Term 2: ampullary tumor |
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