Endoscopic mucosal resection and endoscopic submucosal dissection in the treatment of sporadic nonampullary duodenal adenomatous polyps

Figure 1 Endoscopic resection of a sporadic neoplastic lesion in the duodenum using endoscopic mucosal resection technique. A: Sessile lesion in the descending duodenum seen with white light (type 0 - Isp of the Paris classifi-cation); B: Same lesion after chromoendoscopy with indigo carmine; C: Same lesion after subepithelial injection of diluted adrenalin; D: Resected area after endoscopic mucosal resection; E: Closure of the resected area with clips; F: Lesion resected en bloc. Histology revealed a well-differentiated tubular adenocarcinoma limited to the mucosa, with 7 mm × 8 mm, without lymphatic or vascular invasion.

Figure 2 Endoscopic resection of a sporadic neoplastic lesion in the duode-num using endoscopic submucosal dissection technique. A: Flat lesion in the descending duodenum seen with white light (type 0-IIa of the Paris classi-fication); B: Same lesion after chromoendoscopy with indigo carmine; C: Partial dissection with endoscopic submucosal dissection; D: Dissection plan where the submucosal layer and the partially dissected lesion can be seen; E: Dissected area; F: En bloc dissected lesion. Histology revealed a well-differentiated adenocarcinoma limited to the mucosa, 40 mm × 32 mm, without lymphatic or vascular invasion.