PMC3015908_01
Endoscopic appearance of the polypoidal mass (ar-rows) in the first part of the duodenum.
jsls-13-1-110-g01.jpg
PMC3015908_01_jsls-13-1-110-g01.jpg
F1
Endoscopy revealed a sessile polypoidal mass in the posterior aspect of the first part of the duodenum (Figure 1), 4 cm proximal to the ampulla, from which a biopsy was taken.
CT scan of the lesion.
jsls-13-1-110-g02.jpg
PMC3015908_01_jsls-13-1-110-g02.jpg
F2
A CT scan showed a broad-based 3-cm x 3-cm mass limited to the duodenal mucosa with no evidence of luminal obstruction, serosal infiltration, or lymph node involvement (Figure 2).
Stapler applied to distal margin: (A) antrum; (B) second part of duodenum; (C) head of pancreas; arrow points to tip of the endoscope.
jsls-13-1-110-g03.jpg
PMC3015908_01_jsls-13-1-110-g03.jpg
F3
A 45-mm (blue color) endo-GIA stapler was applied on the duodenum and fired 2cm to 3cm distal to the margin of the tumor, guided by the endoscope (Figure 3).
Gastrojejunostomy with endostapler: (A) divided end of antrum; (B) jejunum.
jsls-13-1-110-g04.jpg
PMC3015908_01_jsls-13-1-110-g04.jpg
F4
Reconstruction was achieved by a conventional Rouxen-Y gastrojejunostomy with 60-mm blue endo-GIA stapler (Figure 4).