Preliminary experience of hybrid endoscopic submucosal dissection by duodenoscope for recurrent laterally spreading papillary lesions

Table 1 Previous characteristics of patients with recurrent laterally spreading duodenal papillary lesions

Case	Pathological characteristics of initial resected specimen	En bloc resection	Complete resection	The first recurrent time (mo)	Time of follow-up (mo)	Previous endoscopic managements
Case 1	Tubulovillous adenoma with local HIN	Yes	Yes	31	96	Endoscopic snare papillectomy, and multiple APC ablation for adenoma recurrence and three ERCP procedures for biliary stones and acute cholangitis
Case 2	Tubulovillous adenoma with local LIN	Yes	Yes	15	15	Endoscopic snare papillectomy

HIN: High-grade intraepithelial neoplasia; LIN: Low-grade intraepithelial neoplasia; APC: Argon plasma coagulation; ERCP: Endoscopic retrograde cholangiopancreatography.

Table 2 Main characteristics of patients in this study

Characteristics	Case 1	Case 2
Age (yr) /sex	54/male	54/female
Clinical symptoms	Negative	Negative
Physical and laboratory examinations	Normal	Normal
Recent endoscopic characteristics	Laterally spreading adenomatous lesion with a diameter of 1.5 cm on the resected scar	A red and protuberant laterally spreading lesion with a diameter of 1 cm on the resected scar
Total procedure time (min)	107	84
Hybrid ESD procedure time (min)	57	30
Bleeding and wound control time (min)	24	22
ERCP procedure time (min)	16	15
ERCP characteristics	No intraductal growth of lesion, but biliary stones with dilated biliary and pancreatic ducts; bile duct stent (10 Fr in diameter, 8 cm in length) and pancreatic stent (7 Fr in diameter, 8 cm in length) placement	No intraductal growth of lesion and no dilatation of biliary and pancreatic ducts; biliary stent (10 Fr in diameter, 3 cm in length) and pancreatic stent (5 Fr in diameter, 7 cm in length) placement
IDUS characteristics	Clear layer of the biliary and pancreatic ducts without intraductal extension; bile duct stones with dilated biliary and pancreatic ducts	Clear layer of the biliary and pancreatic ducts without intraductal extension; no dilatation of biliary and pancreatic ducts
No. of endoscopic clips	2	5
Size of resected specimen (cm)	1.4 × 1.0	2.0 × 1.5
Histology of resected specimen	Tubulovillous adenoma	Tubulovillous adenoma
En blot resection	Yes	Yes
R0 resection	Yes	Yes
Complications	None	Postoperative transient hyperamylasemia
Postoperative hospital stay (d)	4	4

ERCP: Endoscopic retrograde cholangiopancreatography; ESD: Endoscopic submucosal dissection; IDUS: Intraductal ultrasound.