ASGE DDW Videos from Around the World | 2026-TECHNICAL APPROACH TO ENDOSCOPIC SUBMUCOSAL DISSECTION OF A LARGE DUODENAL PERIAMPULLARY GANGLIOCYTIC PARAGANGLIOMA

TECHNICAL APPROACH TO ENDOSCOPIC SUBMUCOSAL DISSECTION OF A LARGE DUODENAL PERIAMPULLARY GANGLIOCYTIC PARAGANGLIOMA

Video Transcription

Video Summary

A 74-year-old man was found to have a large periampullary duodenal subepithelial lesion. EUS and biopsy suggested a grade I neuroendocrine tumor, but the patient declined surgery because of its risks. The team performed endoscopic submucosal dissection after prophylactic biliary and pancreatic stenting. They used a combination of scissor and needle knives, cap assistance, and clip-and-rubber-band traction to complete en bloc resection safely. Pathology showed a gangliocytic pericanglioma with negative margins and no invasion. The patient recovered well, and follow-up ERCP and PET-CT showed no recurrence.

Asset Subtitle

Endoscopy in Action
Submitted by Dennis Yang

Keywords

periampullary duodenal lesion

endoscopic submucosal dissection

gangliocytic pericanglioma

biliary and pancreatic stenting

en bloc resection