Complete Resection of Duodenal Cyst With Adenoma by Using Clips Anchored Endloop of Protrusion Roots to Ligation

A 68-year-old male presented with a smooth, approximately 3.5-cm protrusion in the descending part of the duodenum observed during esophagogastroduodenoscopy (Figure 1a,b). Endoscopic ultrasonography indicated anechoic areas within the protrusion, suggesting a cyst (Figure 1c). Endoscopically, we first used clips anchored endloop of protrusion roots to ligation, followed by the resection of the protrusion (Figure 1d,e), with no perforation or bleeding observed at the resection site (Figure 2a). Postoperative pathology revealed two nodules at both ends of the duodenal mass (Figure 2b), the larger one measuring 1.2 × 1.2 × 1.2 cm, which was cystic upon sectioning, lined with mucinous epithelium, consistent with a mucinous cyst; the smaller one measuring 1.2 × 0.8 × 0.6 cm, characterized by proliferating glands with fibrous tissue proliferation, consistent with a duodenal adenoma (Figure 2c,d). To our knowledge, cysts are usually not removed, and endoscopic resection in the duodenum is prone to perforation and bleeding 1, 2. This case emphasizes the importance of resecting such smooth and large cysts, as they may be associated with neoplasms. Additionally, the use of clips can anchor the endloop of protrusion roots, and ligation can interrupt blood supply, making the resection less prone to perforation and bleeding, potentially offering a superior approach. This study was supported by the Health Commission of Sichuan Province (No. 24LCYJPT04). We confirm that informed consent was obtained from the patient for the publication of their information and imaging. The authors declare no conflicts of interest.