Green indocyanine-guided inside-out mucosotomy for duodenal endoscopic submucosal dissection with no possibility of circumferential incision

Abstract Text A 49-year-old patient was referred for a 45 mm Paris 0-IIa duodenal adenoma in the descending duodenum (D2) without papillary involvement. ESD was chosen due to a depression in the lesion and high-grade dysplasia on biopsy. During ESD, despite saline immersion and traction, access to the caudal part of the lesion was difficult and a circumferential incision could not be achieved. To address this, green indocyanine dye was injected beneath the lesion. This allowed the caudal extent of the lesion to be delineated and an inside-out mucosotomy to be performed. Histopathology confirmed a tubulovillous adenoma with low and high grade dysplasia with focal low grade dysplasia at the horizontal margin. Nevertheless, this technique permitted to attempt completion of the resection which would have risked early termination.

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Publication History

Article published online:
27 March 2025