Endoscopic resection of an ampullary gangliocytic paraganglioma

Dr. Patrick YachimskiPatrick Yachimski, MD, MPH from Vanderbilt University Medical Center presents this VideoGIE article titled “Endoscopic resection of an ampullary gangliocytic paraganglioma.” 

This video case depicts endoscopic examination and resection of a subepithelial ampullary lesion, histopathologically identified following resection as a gangliocytic paraganglioma.

This case represents an unusual ampullary neoplasm. While most neoplasms resected in the periampullary region are adenomas, a number of lesions of alternative etiology may be identified.

Take-home points from this video case include:

1) The role of careful endoscopic inspection of the lesion with respect to the papillary orifice, to determine the need for post-resection stent therapy (ie, pancreatic duct stent for pancreatitis prophylaxis;

2) The role of endoscopic ultrasound in lesion evaluation prior to resection;

3) Histopathologic characterization of this unusual lesion, including cell morphology and special immunohistochemical stains.

Watch the video case here.

Figure 1. A, Visualization of the submucosal lesion in the distal, anterior wall of the duodenal bulb. B, A submucosal injection was performed using dilute indigo carmine, dilute adrenaline, and succinylated gelatin, followed by a circumferential mucosal incision. C, Endoscopic submucosal dissection was performed. D, The lesion was completely excised en bloc, leaving a clear mucosal defect.

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