WEO Video: Dr Michael J Bourke
Dr Michael J Bourke demonstrates piecemeal resection of a laterally spreading tumor (LST) of the duodenal papilla
Dr Michael J Bourke, Director of Gastrointestinal Endoscopy, Westmead Hospital, Sydney, Australia demonstrates piecemeal resection of a laterally spreading tumor (LST) of the duodenal papilla at the July 2011 Hong Kong Endoscopy Workshop.
LSTs of the duodenal papilla represent some of the most challenging cases for the modern therapeutic endoscopist. Situated at the junction of the mid- and foregut, these lesions are highly vascular and located in a relatively thin part of the intestinal wall. As a result, the potential for therapeutic misadventure – especially bleeding and perforation - is high. Removing these lesions is a job for experts only! In this video, Dr Michael Bourke beautifully demonstrates the necessary careful, stepwise approach to debulking these tumors. First, the likely orifice of the bile duct is located: frequently this is a challenge, given the enormous distortion of the ampullary anatomy. The tumor is then resected stepwise using slow cooking by snare electrocautery. As Dr Bourke points out, it is essential for the endoscopist not to get greedy: trimming lumps of tumor too close to the duodenal wall invites perforation. Once the bulk of the tumor has been removed piecemeal, the bile duct is deeply cannulated and one or more stents are placed to ensure biliary drainage. At the end of the procedure, the resected tissue is recovered – usually by endoscopic netting – for histologic analysis
This video was taken during during the the July 2011 Hong Kong Endoscopy Workshop at the Prince of Wales Hospital in Hong Kong, China.
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