Endoscopic papillectomy: ‘be prepared for unexpected’

Abstract

An elderly patient presented with dyspeptic symptoms. Endoscopic evaluation, including side-view evaluation, revealed a bulky major ampulla with smooth mucosa and eccentric papillary orifice opening (figures 1 and 2). Endoscopic ultrasound confirmed a 29×16 mm subepithelial mass lesion within the papilla, with dilation of both the common bile duct (12 mm) and pancreatic duct (PD) (8 mm) (double-duct sign) (online supplemental video). The lesion was limited to the papilla with intact muscularis propria and no ductal infiltration. Endoscopic snare papillectomy was performed using a duodenoscope. Immediately after the papillectomy, a large defect (6 mm) was identified in the central part of …