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Endoscopic Resection of Complex Duodenal Polyps

In this episode of the Gastroenterology and Endoscopy podcast, we discuss a challenging case involving a pedunculated duodenal adenoma. These types of polyps present unique challenges for endoscopists, requiring meticulous planning for a successful procedure. The goal is to achieve a complete R0 resection, removing the entire lesion without leaving any microscopic remnants. We explore strategies to prevent migration of the polyp into the bowel, such as positioning the patient in a decubitus supine position or using an antimotility agent. The endoscopist and assistant must be on high alert to catch the polyp with the snare, and having a Roth's net on standby is recommended. Chapters: [00:02:16] Preventing complications. [00:04:10] Preparation is key. Resources: 1. Endoscopic Resection of Complex Duodenal Polyps (https://www.thepracticingendoscopist....) 2. Duodenal Polyp Resources on EndoCollab (https://community.endocollab.com/sear...) Quotes: • 00:02:52 - "By allowing the neoplasm to float, we reduce the chances of transmitting electrosurgical current to the base of the lesion, minimizing the risk of perforation." • 00:03:06 - "And when it comes to closing the wound post-resection, clips are a must." Topics Discussed: 1. Introduction to Pedunculated Duodenal Adenoma: Brief description of the polyp’s location and importance of meticulous planning for resection. 2. Achieving Complete Resection (R0): Importance of removing the entire lesion and considerations to make during resection. 3. Preventing Polyp Migration: Strategies to prevent the polyp from moving into the distal bowel. 4. Complication Prevention: Discussion on measures to prevent complications during and after endoscopic resection. 5. Tools and Techniques: Exploration of various tools (snare, Roth’s net, distal transparent cap) and techniques (submucosal injection, underwater resection, use of endoloops and clips). 6. Managing Immediate and Delayed Bleeding: Importance of using endoscopic clips and hemostatic hydrogels, especially in patients on anticoagulation. 7. Proximity to the Papilla of Vater: Ensuring correct identification of the lesion’s location and planning the resection accordingly. 8. Post-procedure Care: Importance of starting proton pump inhibitors post-procedure. 9. Final Thoughts and Goodbye: Summing up the key takeaways from the episode and bidding farewell to the listeners. Keywords: Gastroenterology, Endoscopy, pedunculated duodenal adenoma, endoscopic procedures, complications,closing the wound, post-resection, clips, duodenal endoscopic resections, bleeding complications, hemostatic hydrogels, Puristat, anticoagulation, proton pump inhibitors, healing process, polyp's proximity, papilla of vater, ampullary lesion, resection, side-viewing endoscope, complete R0 resection, pedunculated duodenal adenomas, preparation, plan, outcome, patient, insightful, helpful, practice https://www.gastroendopod.com (https://www.gastroendopod.com/)