Post written by Yoriaki Komeda, MD, PhD, from the Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan.

We performed endoscopic submucosal dissection (ESD) with reinforcement using a laparoscopic approach (duodenal-laparoscopic and endoscopic coordinated surgery [D-LECS] with ESD) for a duodenal cavernous hemangioma.

Cavernous hemangiomas including duodenum are derived from the submucosa. Even minimally invasive endoscopic procedures—such as polyp resection, EMR, and argon plasma coagulation—may cause heavy bleeding or perforation.

Although laparoscopic resection is reportedly useful for duodenal lesions, it is highly invasive and associated with difficulty in identifying the exact tumor location.　

This technique for a duodenal cavernous hemangioma has been reported to facilitate postexcisional suturing and reduce the risk of perforation.

Other endoscopists can learn a safer technique of ESD with reinforcement using a laparoscopic approach (D-LECS with ESD) for a duodenal cavernous hemangioma >1 cm.

Endoscopic image of a cavernous hemangioma in the third portion of the duodenum.

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