En bloc resection of intestinal-type adenoma extending to the minor duodenal papilla by underwater endoscopic mucosal resection with a forward-viewing endoscope.
Risa Nakamura, Yoshitaka Nawata, Tomoaki Naka et al.
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Case in brief
A woman in her 60s had a 10-mm depressed lesion in the descending duodenum, with endoscopic imaging suggesting involvement of the minor papilla. Because a side-viewing endoscope was judged to offer inadequate maneuverability for this lesion, clinicians used a forward-viewing dual-channel endoscope to perform underwater endoscopic mucosal resection en bloc. Histopathology showed a 15 × 13-mm intestinal-type adenoma with negative margins. The papilla lay at the tumor margin and had no luminal orifice, supporting classification as a superficial non-ampullary duodenal epithelial tumor extending secondarily to the papilla.
What made this case unusual
The lesion involved the minor papilla, yet its orientation favored a forward-viewing dual-channel endoscope over the conventionally used side-viewing scope. The papilla’s position at the tumor margin and absence of a luminal orifice also clarified that this was a non-ampullary duodenal tumor extending to the papilla.
Diagnostic / clinical pearl
For lesions near the minor papilla, assess orientation and scope maneuverability before resection; a forward-viewing endoscope may provide a more direct, stable approach in selected cases.