Endoscopic diagnosis and treatment of a patient with giant adenoma of major duodenal papilla

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.