ASGE Endoscopy Live: Endoscopic Retrograde Cholangiopancreatography (ERCP)

Video Transcription

Video Summary

Dr. Siddiqui presented a case of a 79-year-old woman with a duodenal polyp that was ultimately found to be an ampullary adenoma. The polyp was identified during an EGD for evaluation of iron deficiency anemia. The initial forward-viewing scope did not clearly show the involvement of the ampulla, so a duodenoscope was used, which clearly showed involvement of the polyp into the ampulla. An EUS was performed to evaluate for biliary or pancreatic duct involvement, and since there was none, an ERCP with papillectomy was performed. Dr. Siddiqui discussed the importance of identifying the ampulla before performing polypectomy to avoid inadvertent removal of the ampulla and severe complications such as necrotizing pancreatitis. The panel discussed different techniques for ampullectomies, including injecting both ducts, doing a biliary sphincterotomy, and using a wire to guide the snare. They also discussed surveillance strategies for patients with duodenal and ampullary adenomas. The patient in this case will be admitted for overnight observation and will have a PD stent placed. Prophylactic measures such as clipping or using hemostatic gels or powders were suggested to prevent bleeding.

Asset Subtitle

Ampullectomy
Uzma D. Siddiqui, MD, MASGE

Keywords

ampullary adenoma

duodenal polyp

EGD

iron deficiency anemia

ampulla involvement

ERCP