Endoscopic ampullectomy of a large neuroendocrine tumor using underwater EMR technique

Kumar_headshot Post written by Anand R. Kumar, MPH, MD, from the Division of Gastroenterology, Thomas Jefferson University, Philadelphia, Pennsylvania.

A young man presented with an incidental 35-mm ampullary neuroendocrine tumor detected on upper endoscopy. We chose to do an underwater ampullectomy and obtained negative margins.

Endoscopic ampullectomy is an advanced procedure with variable techniques. The underwater EMR technique is not one of them. The safety of this technique has been shown in the colon and duodenum. We used this video to show its effectiveness and safety for ampullectomy. We also think this may be a superior technique for ampullectomy compared to submucosal injection or gas insufflation especially for sub-epithelial lesions, and we demonstrated that in the form of a sketch included in the video and the manuscript.

We hope to highlight the physics of water immersion and how endoscopists can use that to their advantage in removing large lesions with relatively simple tools. In addition, we also demonstrated usage of clips around the ampulla with a forward viewing endoscope and a distal attachment, which is another area where most of us struggle with a side-viewing duodenoscope.

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

Leave a Comment

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s