Endoscopic papillectomy is currently the “gold standard” for adenomas of major duodenal papilla treatment. However, the surgical approach is also valid in the following situations: presence of atypical cells in T1 and advanced tumor stages, intraductal lesion extending more than 20 mm; impossibility to perform endoscopic papillectomy due to technical difficulties (e.g., duodenal diverticulum, tumor mass size more than 4 cm); incomplete resection after previous endoscopic papillectomy with tumor cells present on the resection margins; adenoma recurrence not responding to repeated endoscopic therapy. This article presents a clinical case of successful endoscopic treatment of major duodenal papilla adenoma extending beyond the conventional limits of duodenal wall involvement.
Budzinskiy et al. (Fri,) studied this question.