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Endoscopic submucosal dissection for a laterally spreading ampullary carcinoma
Osamu Dohi1, Tsugitaka Ishida1, Toshifumi Doi1
1Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan.
Summary
This study demonstrates the successful en bloc resection of an ampullary lesion using endoscopic submucosal dissection (ESD) with a Clutch Cutter. The procedure involved creating submucosal tunnels and prophylactic closure to prevent complications.
Area of Science:
- Gastroenterology
- Endoscopy
- Surgical Oncology
Background:
- Ampullary lesions require precise resection to preserve organ function.
- Endoscopic submucosal dissection (ESD) offers a minimally invasive approach for gastrointestinal tumor removal.
Purpose of the Study:
- To showcase the technical feasibility and efficacy of ESD for ampullary lesions.
- To detail the step-by-step procedure using specific endoscopic tools.
Main Methods:
- Endoscopic submucosal dissection (ESD) performed under conscious sedation.
- Utilized a Clutch Cutter for submucosal layer dissection and lesion removal.
- Created submucosal tunnels to delineate dissection planes.
- Performed prophylactic closure of the mucosal defect with endoclips and fibrin glue.
Main Results:
- Achieved en bloc resection of the ampullary lesion.
- Successfully placed biliary and pancreatic stents.
- No immediate complications like perforation or bleeding were reported post-procedure.
Conclusions:
- Endoscopic submucosal dissection (ESD) is a viable and effective technique for resecting ampullary lesions.
- The described technique, utilizing submucosal tunnels and specific tools, facilitates complete tumor removal.
- Prophylactic measures enhance safety and reduce the risk of post-procedural complications.
