Dohi Osamu, Ishida Tsugitaka, Doi Toshifumi, Yoshida Naohisa, Itoh Yoshito
Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan.
VideoGIE. 2021 Dec 17;7(2):79-81. doi: 10.1016/j.vgie.2021.11.001. eCollection 2022 Feb.
Video 1We performed endoscopic submucosal dissection with the patient under conscious sedation. After making markings around the lesion, we incised the mucosa from the oral side of the ampullary lesion and dissected the submucosal layer using a Clutch Cutter. We created 2 submucosal tunnels to identify the dissection line of the ampulla. After completion of the tunnels, we performed a mucosal incision circumferentially and dissected the submucosal layer except the ampulla. Subsequently, we removed the ampulla directly above the muscle layer of the duodenum using the Clutch Cutter. En bloc resection was achieved. After resecting the lesion, a biliary stent and pancreatic stent were placed into the common bile duct and pancreatic duct, respectively. Prophylactic closure of the mucosal defect was performed using endoclips and a polyglycolic acid sheet with fibrin glue to prevent delayed perforation and bleeding.
视频1
我们在患者清醒镇静状态下进行了内镜黏膜下剥离术。在病变周围做好标记后，我们从壶腹病变的口腔侧切开黏膜，并使用圈套切割器剥离黏膜下层。我们创建了两条黏膜下隧道以确定壶腹的剥离线。完成隧道后，我们进行了环形黏膜切开，并剥离了除壶腹外的黏膜下层。随后，我们使用圈套切割器在十二指肠肌层正上方切除壶腹。实现了整块切除。切除病变后，分别在胆总管和胰管内放置了胆管支架和胰管支架。使用内镜夹和带有纤维蛋白胶的聚乙醇酸片对黏膜缺损进行预防性封闭，以防止延迟穿孔和出血。
