2023 Volume 102 Issue 1 Pages 27-30
Background: Water Pressure Method (WPM) and Gel Immersion Endoscopy (GIE) have been reported to be efficacious to improve maneuverability during endoscopic submucosal dissection.
Case: A 69-year-old woman required a difficult ESD on a 30 mm 0-IIa lesion in the medial wall of the superior duodenal angle. Endoscopic maneuverability was improved markedly by changing from under insufflation to WPM. Due to bleeding, the visual field was poor with WPM, but a good visual field was secured by changing to GIE. The lesion was resected en bloc. Clip suture of mucosal defects was facilitated by changing from insufflation to water immersion.
Conclusion: In a patient with a difficult duodenal ESD, we were able to overcome various possible difficulties by utilizing the advantages of WPM and GIE.
