Safety and Efficacy of a Novel Technique Underwater Ampullectomy Underwater endoscopic mucosal resection is a promising technique for ampullary adenomas requiring endoscopic ampullectomy. While this technique has been used in the resection of adenomas in other parts of the gastrointestinal tract, its application for an ampullectomy is novel. Traditional ampullectomy involves a hot nerve resection with carbon dioxide and sufflation. Of note, there is typically a 37% polyp recurrence rate that's been reported in some studies. There's always a risk of bleeding and perforation. We present a 68-year-old female with cardiac comorbidities who underwent successful underwater ampullectomy for an ampullary adenoma, achieving end-block resection with negative margins and no complications. Initial endoscopic evaluation identified a hypoechoic mass in the ampulla, which measured 8 x 6 mm with well-defined borders and no invasion into the bile or pancreatic ducts. Sterile water was used to immerse the lumen of the duodenum using a water pump and thus naturally lifting the adenoma. The adenoma was then excised using a 20 mm snare under cutting current via the underwater EMR technique. A Roth net was then used to retrieve the adenoma, and stents were placed in both the pancreatic and biliary duct respectively. Underwater ampulectomy is a feasible and safe option for resecting ampullary adenomas. It offers a promising alternative, enhancing precision and safety while minimizing thermal damage, reducing post-procedural bleeding, and perforation risks.

underwater EMR

ampullary adenomas

patient safety

adenoma recurrence

innovative technique