Endoscopy 2019; 51(04): S27
DOI: 10.1055/s-0039-1681247
ESGE Days 2019 oral presentations
Friday, April 5, 2019 08:30 – 10:30: Video upper GI 1 South Hall 1B
Georg Thieme Verlag KG Stuttgart · New York

SUBMUCOSAL TUNNELING ENDOSCOPIC RESECTION (STER) FOR OBSTRUCTIVE DUODENAL LIPOMA

G Mavrogenis
1   Endoscopy, Mediterraneo Hospital, Mytilene, Greece
,
F Bazerbachi
2   Mayo Clinic, Rochester, United States
,
I Tsevgas
3   Mediterraneo Hospital, Athens, Greece
,
D Zachariadis
3   Mediterraneo Hospital, Athens, Greece
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

 

A 35-year-old male presented with a 6-month history of postprandial epigastric pain and nausea. Gastroscopy revealed a 3 cm soft subepithelial mass that originated from the duodenal bulb and prolapsed into the antrum. Endoscopic ultrasonography showed a hyperechoic homogenous mass that originated from the submucosal layer of the duodenum, consistent with a lipoma. The mass had a broad base, preventing the application of endoscopic loop ligation. Therefore, submucosal tunneling endoscopic resection (STER) technique was applied. A mixture of hydroxyethyl starch (500 ml) with methylene blue (1 ml) and epinephrine (1 mg) was injected above the pylorus. Then, a submucosal pocket was created at the lesser curvature of the antrum that was extended all along the length of the superior wall of the duodenal bulb. The endoscope was advanced between the superior pole of the lesion and the duodenal wall. Dissection of the inferior and posterior part of the lesion was achieved with a blunt tip knife in order to diminish the risk of perforation due to poor visualization or due to tangential access. In addition, a tapered tip cap was used in order to push the endoscope into the tight space between the mass and the underlying duodenal mucosa. Finally, the lesion was completely resected and the specimen was retrieved with a basket. At the end of the procedure small incisions were made around the edges of the entrance of the tunnel. These superficial defects allowed clip grip for traction and apposition. Using two clips, the mucosal defect was partially closed. Complete closure was achieved with additional clips. The patient was discharged after 24 hours and had an uneventful recovery. At 10 months of follow up the patient remains asymptomatic and endoscopy showed a smooth passage of the gastroscope to the duodenum.