PMC4133036_01
Periampullary bleeding which appears to arise from underneath the hood of the major papilla.
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Copious washing revealed the bleeding to be emanating from directly underneath the hood of the major papilla (Fig. 1).
No distinct lesion of the papilla or periampullary mucosa is apparent even after blood is cleared away with copious washing.
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Despite copious washing and a clear view of the papilla, no definitive vascular malformation could be identified (Fig. 2).
Progressive reduction in bleeding with circumferentially applied APC (current: 40 W, flow rate: 1.4 L/min) beginning at the 12 o'clock position (A) and moving laterally (B) until complete hemostasis is achieved (C). Note the absence of thermal damage to the papilla.
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Thermal ablation of the periampullary mucosa with APC resulted in progressive reduction of bleeding until complete hemostasis was achieved (Fig. 3A-C).