Endoscopy 2020; 52(02): E55-E56
DOI: 10.1055/a-0992-9084
E-Videos
© Georg Thieme Verlag KG Stuttgart · New York

Underwater endoscopic papillectomy using double-balloon endoscopy

Tatsuhiro Yamazaki
Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
,
Daisuke Uchida
Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
,
Yasushi Yamasaki
Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
,
Takeshi Tomoda
Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
,
Kazuyuki Matsumoto
Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
,
Hironari Kato
Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
,
Hiroyuki Okada
Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
› Author Affiliations
Further Information

Corresponding author

Tatsuhiro Yamazaki, MD
Department of Gastroenterology
Okayama University Hospital
2-5-1 Shikata-cho
Okayama 700-8558
Japan   
Fax: +81-86-2255991   

Publication History

Publication Date:
09 September 2019 (online)

 

A 70-year-old woman with familial adenomatous polyposis (FAP), who had undergone proctocolectomy for FAP and laparoscopic total gastrectomy with Roux-en-Y reconstruction for multiple early gastric cancers, underwent double-balloon endoscopy (DBE) for duodenal adenoma screening. DBE revealed an ampullary tumor, diagnosed as a tubular adenoma by biopsy ([Fig. 1 a]). For resection of the ampullary tumor, we planned an underwater endoscopic papillectomy.

Zoom Image
Fig. 1 Endoscopic images showing: a an adenoma of the papilla of Vater; b the ensnared papilla during underwater papillectomy (underwater view); c the appearance following underwater papillectomy (underwater view); d insertion of a pancreatic stent into the main pancreatic duct (MPD) and closure of the mucosal defect with clips.

Video 1 Underwater endoscopic papillectomy of an adenoma of the papilla of Vater.


Quality:

We used a short-type double-balloon endoscope (EI-580BT; Fujifilm, Tokyo, Japan), equipped with an auxiliary waterjet injection cap (Water Please AF-WP1; Forte Grow Medical Co. Ltd., Tochigi, Japan) to allow irrigation while leaving the operative channel free. We performed underwater papillectomy using a single-use snare (Captivator II; Boston Scientific, Tokyo, Japan) without submucosal injection ([Fig. 1 b, c]). A 5-Fr plastic stent (Geenen pancreatic stent; Cook Medical, Tokyo, Japan) was placed into the main pancreatic duct to prevent post-papillectomy pancreatitis and the mucosal defect was closed with clips (QuickClip Pro; Olympus, Tokyo, Japan) ([Fig. 1 d]).

The patient did not experience any early adverse events and was discharged on postoperative day 7. The pathological diagnosis of the resected tumor confirmed it to be a tubular adenoma and the resection margins were free of dysplasia.

Endoscopic papillectomy (EP) is a less invasive treatment for localized ampullary tumors; however, the procedure is not standardized, and severe adverse events such as pancreatitis, perforation, bleeding, and cholangitis may occur after the procedure [1] [2]. Underwater endoscopic mucosal resection (EMR) has been reported as a novel approach for the treatment of small duodenal adenomas (≤ 20 mm) [3], but the efficacy of the procedure and its safety for ampullary tumors are unclear. In this case, we applied the underwater EMR technique to an endoscopic papillectomy procedure using DBE. The underwater EMR technique has been similarly reported to be a safe and novel treatment approach for an ampullary tumor in a patient with altered gastrointestinal anatomy [4].

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Competing interests

None


Corresponding author

Tatsuhiro Yamazaki, MD
Department of Gastroenterology
Okayama University Hospital
2-5-1 Shikata-cho
Okayama 700-8558
Japan   
Fax: +81-86-2255991   


Zoom Image
Fig. 1 Endoscopic images showing: a an adenoma of the papilla of Vater; b the ensnared papilla during underwater papillectomy (underwater view); c the appearance following underwater papillectomy (underwater view); d insertion of a pancreatic stent into the main pancreatic duct (MPD) and closure of the mucosal defect with clips.