Duodenal Laparoscopy and Endoscopy Cooperative Surgery Combined With Endoscopic Nasopancreatic Drainage and Endoscopic Nasobiliary Drainage for a Duodenal Adenoma Near the Papilla of Vater: A Case Report.

Duodenal laparoscopy and endoscopy cooperative surgery (D-LECS) for superficial non-ampullary duodenal tumors has been increasingly performed as a minimally invasive treatment for lesions with a high risk of complications when treated by endoscopy alone. However, for tumors near the papilla of Vater, the optimal treatment strategy has not been established because of the risk of pancreatitis and cholangitis associated with papillary injury. We report a case of duodenal adenoma near the papilla of Vater successfully treated by D-LECS combined with endoscopic nasopancreatic drainage (ENPD) and endoscopic nasobiliary drainage (ENBD). A 70-year-old woman was found to have a 0-IIa adenoma adjacent to the papilla in the descending portion of the duodenum and underwent D-LECS with endoscopic retrograde cholangiopancreatography assistance. After Kocher mobilization, endoscopic en bloc resection was performed. The mucosal defect was closed using endoscopic mucosal closure and reinforced with laparoscopic seromuscular suturing. To prevent postoperative complications, ENPD and ENBD were performed. Pathological examination confirmed negative resection margins, and the patient was discharged with an uneventful postoperative course. ENPD and ENBD after D-LECS were technically feasible without interfering with endoscopic manipulation. This combined approach may be a selective organ-preserving strategy for carefully selected duodenal tumors located near the papilla of Vater.