VideoGIE| Volume 84, ISSUE 3, P533-534, September 2016

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Ampullary polyp resection as treatment for severe GI bleeding

Published:March 25, 2016DOI:
      A 50-year-old woman presented with melena that required transfusion. EGD revealed ampullary bleeding (Video 1, available at She was transferred to our institution with a hemoglobin count of 7 gm/dL and hemodynamic instability. Duodenoscopy revealed a 1-cm bleeding lesion projecting from the superior portion of the ampulla (Fig. 1A ). EUS showed a villous projection, 9 mm × 3 mm, with no invasion into the submucosa. Color flow Doppler ultrasonography identified a vessel within the lesion (Fig. 1B). ERCP demonstrated no intraductal invasion or abnormalities. Coagulation or endoclip application would probably not have eradicated the bleeding polyp; therefore, ampullary polyp resection was performed to treat her life-threatening bleeding. The ampullary polyp was lifted by the injection of epinephrine (1:10,000) diluted in normal saline solution and then removed en bloc by use of a hot snare and coagulation current. Biliary and pancreatic sphincterotomies were performed, and a 5F × 4-cm plastic stent was placed into the ventral pancreatic duct to reduce the risk of pancreatitis. After polypectomy, the patient’s bleeding ceased. Pathologic examination revealed an inflammatory polyp. Follow-up EGD 4 months later demonstrated no ampullary abnormality. Bleeding is a known adverse event of ampullary resection or papillectomy. However, ampullary polyp resection as treatment for life-threatening ampullary bleeding is exceedingly rare.
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      Figure 1A, Duodenoscopic view showing an ampullary lesion that was actively bleeding. B, EUS with color flow demonstrating a vessel within an ampullary lesion.
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