A case of periampullary adenomyoma that potentially obviated the need for pancreaticoduodenectomy

Pancreaticoduodenectomy (PD) is the standard treatment for duodenal cancers suspected of submucosal invasion. Pathological diagnosis from duodenal biopsy samples has some limitations. We present the case of a man in his 70s with bile duct dilation and a suspected parapapillary duodenal cancer. Given the uncertainty of the biopsy, endoscopic submucosal dissection (ESD) was performed as a minimally invasive diagnostic alternative to PD. Histological diagnosis revealed an adenomyoma with high-grade adenoma, underscoring the efficacy of ESD in accurately diagnosing periampullary lesions. For patients with periampullary lesions, this case suggests that ESD could serve as a less invasive approach, potentially avoiding overtreatment, such as radical surgery.