Endoscopic removal of a pedunculated early duodenal cancer: diagnostic value of endoscopic ultrasound.

A 79-year-old Japanese woman was admitted to our hospital for evaluation of a polypoid lesion in the second portion of the duodenum. Radiographic and endoscopic examinations of the upper gastrointestinal tract indicated that this mass was pedunculated and had a nodular surface. Endoscopic ultrasonography demonstrated a hypoechoic tumor limited to the mucosa without lymph node involvement. Endoscopic polypectomy was performed. Histologic examination showed a tubular adenocarcinoma arising in an adenoma with invasion limited to the mucosa. Findings were consistent with complete endoscopic resection. Follow-up over a 12-month period has disclosed no evidence of tumor recurrence. Endoscopic polypectomy using information from endoscopic ultrasonography would appear to be a safe and effective method for diagnosis and treatment of pedunculated early duodenal cancers.