Year 2025 / Volume 117 / Number 7
Letter
Successful removal of a duodenal lesion in a difficult location using “a sandwich method”

411-412

DOI: 10.17235/reed.2024.10477/2024

De-Feng Li, Sheng-Gang Zhan, Yan-Hui Tian, Chen Kong, Jun Yao, Li-Sheng Wang, Ben-Hua Wu,

Abstract
A 69-year-old woman was diagnosed with a duodenal adenoma near major duodenal papilla during cancer screening examination (Figure 1A). Therefore, endoscopic mucosal resection (EMR) was proposed to remove the duodenal lesion. Unfortunately, satisfactory visualization of the duodenal lesion was not obtained during gastroscopic operation. Unexpectedly, duodenoscopy provided optimal visualization of the duodenal lesion. Consequently, the “sandwich method” using duodenoscopy-gastroscopy-duodenoscopy was successfully performed to remove the challenging duodenal lesion. Firstly, the duodenoscopy was used to create a submucosal bleb through injecting saline containing 0.3 % indigo carmine. Subsequently, the gastroscopy with a transparent capwas used to remove the duodenal lesion with en bloc resection. Then, the duodenoscopy was reused to close the mucosal defect. Finally, pathologic examination showed a tubule-villous adenoma. The patient was recovered uneventfully, and discharged 2 days later.
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References
1. Alfarone L, Albouys J, Legros R, et al. Endoscopic submucosal dissection of recurrent duodenal adenoma: combined use of multiple strategies for a difficult case. Endoscopy 2024, 56(S 01): E120-E121.
2. Figueiredo M, Yzet C, Lafeuille P, et al. Underwater endoscopic mucosal resection: the best solution for treating local recurrence of duodenal adenoma. Endoscopy 2022, 54(S 02): E844.
3. Heresbach D, Kornhauser R, Seyrig JA, et al. A national survey of endoscopic mucosal resection for superficial gastrointestinal neoplasia. Endoscopy 2010, 42(10): 806-813.
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Li D, Zhan S, Tian Y, Kong C, Yao J, Wang L, et all. Successful removal of a duodenal lesion in a difficult location using “a sandwich method”. 10477/2024


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Publication history

Received: 14/04/2024

Accepted: 20/04/2024

Online First: 20/05/2024

Published: 08/07/2025

Article Online First time: 36 days

Article editing time: 450 days


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