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The procedure addressed technical challenges caused by narrow submucosal space and reduced maneuverability after prior surgery. Submucosal injection, circumferential incision, and water-jet-assisted WPM facilitated en bloc resection without perforation, with complete clip closure of the mucosal defect. Postoperative recovery was uneventful aside from mild pancreatitis, which resolved with conservative care.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/successful-endoscopic-submucosal-dissection-of-a-large-laterally-spreading-tumor-in-distal-jejunum-paper-case-report/459155/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/successful-endoscopic-submucosal-dissection-of-a-large-laterally-spreading-tumor-in-distal-jejunum-paper-case-report/459155.png","ImageObject",300,407,{"name":92,"@type":93},"dabgoudw","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-08","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":29},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What technique was used to perform ESD in the distal jejunum?","Question",{"text":112,"@type":113},"ESD was performed using a newly developed double-balloon enteroscope, supported by the water pressure method with the water jet function.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Why was the first attempt at submucosal dissection difficult?",{"text":117,"@type":113},"It was extremely difficult due to poor maneuverability from prior surgery and a narrow submucosal space.",{"name":119,"@type":110,"acceptedAnswer":120},"What were the main procedural and outcome results?",{"text":121,"@type":113},"En bloc resection was achieved in 263 minutes without perforation, and the mucosal defect was completely closed using endoscopic clips; pathology showed tubular adenoma with pHM0 and pVM0.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},459155,1790755289,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":29,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":129,"read_time":24,"preview_page_count":4},3985747860484,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Article published online: 2026-01-08  \nSuccessful endoscopic submucosal dissection of a large laterally spreading tumor in distal jejunum by the water pressure method using a newly developed double-balloon enteroscope  \n▶Fig. 1 Appearance of the double-balloon enteroscope with the energy device in place. The energy device used for jejunal ESD was the ORISE 1 . 5-mm ProKnife (Boston Scientific Japan, Tokyo, Japan) . ESD, endoscopic submucosal dissection.  \n▶Fig.2 The tip of the double-balloon enteroscope. The ST-hood was modified by cutting off the rubber part and then attached to the tip of the enteroscope, and the balloon tip of the enteroscope also functioned without issues.  \n▶Fig.3 Amber-red color imaging (ACI) during the ESD with the water pressure method. ACI enhances the visualization of the dissection plane within the very thin submucosal layer.  \n▶Fig.4 A white light image and an abdominal radiography after complete suturing of the mucosal defect. The mucosal defect was completely closed by the origami method using endoscopic clips (SureClip; Boston Scientific Japan, Tokyo, Japan) . The radiographic image indicates that the treated lesion was identified in the pelvis, and the procedure was completed without perforation.  \nDespite advances in therapeutic endoscopy, reports of endoscopic resection in the small intestine remain extremely limited, and only a few cases of endoscopic submucosal dissection (ESD) for proximal small intestinal lesions without deep intubation have been reported [1] . Here, we present a case of distal jejunal ESD performed using a newly developed doubleballoon enteroscope ( ▶Video 1) .  \nA man in his fifties with familial adenomatous polyposis was found to have a large tumor in the small intestine. He had a history of total colectomy for rectal cancer. Because of the lesion size, we performed ESD using a double-balloon enteroscope (EN-840T, Fujifilm, Tokyo, Japan) . The enteroscope was inserted trans-orally and advanced to the distal jejunum in the pelvis, where a 50-mm laterally spreading tumor was identified. Submucosal injection of hyaluronic acid was initiated from the distal side, followed by complete circumferential mucosal incision. Submucosal dissection was then attempted; however, it was extremely difficult due to poor maneuverability from prior surgery and the narrow submucosal space. Therefore, the enteroscope was withdrawn,  \n▶Fig.5 A white light image of the specimen with indigo carmine. En-bloc resection was successfully achieved. Pathological diagnosis: Tubular adenoma, intestinal type, pHM0, and pVM0 .  \nand a small-caliber transparent hood (ST hood: DH-33GR, Fujifilm) was attached ( ▶ Fig.1 , ▶ Fig.2) . The water jet function was then applied for the water pressure method (WPM), which facilitated entry into the narrow submucosal space ( ▶ Fig.3) [2,3] . Repeated balloon assisted re-positioning also stabilized maneuverability. Finally, en bloc resection was successfully achieved in 263 minutes  \nMurata Shoma et al. Successful endoscopic submucosal… Endoscopy 2026; 58: E17–E18 | © 2026. The Author(s) . E17  \nVideo 1 Successful endoscopic submucosal dissection of a large laterally spreading tumor in the distal jejunum by the water pressure method using a newly developed double-balloon enteroscope.  \nwithout perforation, and the mucosal defect was completely closed with clips ( ▶ Fig.4 , ▶ Fig.5) . The postoperative course was uneventful except for mild pancreatitis, which resolved conservatively, and the patient was discharged on postoperative day 6 .  \nTo the best of our knowledge, this is the first successful case of distal jejunal ESD. The newly developed double-balloon enteroscope enabled access to the deep small intestine and, with the aid of the water jet function, facilitated precise submucosal dissection using WPM, thereby overcoming the technical difficulties of small intestinal ESD.  \nEndoscopy_UCTN_Code_TTT_ 1AP_ 2AD  \nContributors ʼ Statement  \n\n| Shoma Murata: Conceptu","cbCaimDsN9gbKzUP","https://ap.wps.com/l/cbCaimDsN9gbKzUP","pdf",2921917,"English","# Case presentation\n## Patient background and lesion identification\n## ESD procedure using water pressure method\n# Results and outcome\n## En bloc resection and closure\n## Postoperative course and pathology\n# Discussion\n## Significance and novelty","[{\"question\":\"What technique was used to perform ESD in the distal jejunum?\",\"answer\":\"ESD was performed using a newly developed double-balloon enteroscope, supported by the water pressure method with the water jet function.\"},{\"question\":\"Why was the first attempt at submucosal dissection difficult?\",\"answer\":\"It was extremely difficult due to poor maneuverability from prior surgery and a narrow submucosal space.\"},{\"question\":\"What were the main procedural and outcome results?\",\"answer\":\"En bloc resection was achieved in 263 minutes without perforation, and the mucosal defect was completely closed using endoscopic clips; pathology showed tubular adenoma with pHM0 and pVM0.\"}]","Successful endoscopic submucosal dissection of a large laterally spreading tumor in distal jejunum - paper case report | PDF"]