Endoscopic submucosal dissection for a laterally spreading ampullary carcinoma.

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.