# Endoscopic Papillectomy for Ampullary Adenoma Adjacent to a Cystic Lesion

## TL;DR

This case study shows that endoscopic papillectomy can safely remove ampullary adenomas even when they are near cystic lesions.

## Contribution

The study demonstrates the feasibility of en bloc endoscopic papillectomy for ampullary adenomas adjacent to cystic lesions.

## Key findings

- En bloc endoscopic papillectomy was performed without complications and achieved negative resection margins.
- The cystic lesion was identified as a dilated glandular duct without malignant features.
- Detailed imaging and meticulous planning are essential for successful resection in such cases.

## Abstract

Ampullary adenomas are precancerous lesions with a high risk of malignant transformation. Endoscopic papillectomy is the standard treatment, but the presence of adjacent cystic lesions poses a technical challenge. An 83-year-old man underwent an endoscopic examination, which revealed an ampullary tumor adjacent to a cystic lesion. Endoscopic ultrasound and MRI confirmed its cystic nature. A biopsy diagnosed an intestinal-type adenoma. The patient underwent en bloc endoscopic papillectomy with simultaneous resection of the cystic lesion. The procedure was complication free, and histopathological analysis confirmed a nonmalignant adenoma with negative resection margins. The cystic lesion was identified as a dilated glandular duct without adenomatous components. This case underscores the importance of detailed imaging for preoperative planning. En bloc endoscopic papillectomy is a feasible and safe approach for ampullary adenomas with adjacent cystic lesions. A thorough preoperative assessment and meticulous procedural planning are crucial for achieving complete resection with negative margins.