Duodenal endoscopic submucosal dissection for a large protruded lesion located just behind the pyloric ring with a scissor-type knife

摘要

Recently, endoscopic submucosal dissection (ESD) has been applied to the treatment of GI lesions to enable en bloc curative resection.'’ Generally, large tumor size, pro- truded lesion, poor endoscope maneuverability, and other procedural factors may contribute to the technical diffi- culties of ESD and periprocedural perforation.’ Among ESD procedures for GI lesions, duodenal ESD is the most technically challenging procedure because of the thin wall and narrow lumen of the duodenum, as well as poor maneuverability of the endoscope in the duo- denum.”° Herein, we report the successful en bloc and curative resection of a duodenal lesion presenting with all of the above-mentioned difficulties associated with ESD by performing ESD with a scissor-type knife and the submucosal dissection method (Video 1, available online at www. VideoGIE.org).