EMR of large laterally spreading lesion of the duodenum involving the ampulla

摘要

A 70-year-old woman was referred to our hospitalfor management of a large, nearly circumferential, laterallyspreading lesion (LSL) of the duodenum involvingthe ampulla of Vater (Fig. 1A), which was incidentallydiagnosed during endoscopic investigation of diarrhea.Her medical history included severe chronic obstructivepulmonary disease; rheumatoid arthritis, for whichimmunosuppressive medication was prescribed; andheterozygote factor V Leiden requiring anticoagulanttherapy. Because of the ampulla involvement, magneticresonance cholangiopancreatography was performed andshowed absence of adenoma intraductal extension andabsence of pancreas divisum.