Approach to the endoscopic resection of duodenal lesions

Figure 10 Piecemeal cap-band-assisted mucosectomy (endoscopic mucosal resection). A large, 2.5-cm, nearly flat, duodenal adenoma was found in the second portion of the duodenum along the lateral wall and was examined with narrow-band-imaging, which did not reveal any invasive cancer (A); Cap-band-assisted EMR was performed. Two bands were sequentially deployed (B) and the resultant pseudopolyps were resected leaving behind no macroscopic evidence of residual adenoma (C); Argon plasma coagulation was used to ablate the borders of the polyp and exposed submucosal vessels in order to reduce the risk of adenoma recurrence and delayed bleeding, respectively (D).