Endoscopic resection of minor papilla adenomas (with video)

BackgroundAlthough there are several large series on endoscopic resection of the major duodenal papilla, only commentary on individual cases has been presented on endoscopic minor papilla resection.ObjectiveTo evaluate the technical success and safety of endoscopy for resection of minor papilla adenomas.DesignObservational study.SettingAcademic tertiary-referral center.PatientsConsecutive patients referred for endoscopic resection of minor papilla adenomas over a 12-month period.InterventionsAll patients underwent an EUS before an ERCP to exclude ductal involvement by the tumor and for evaluation of pancreatic-ductal anatomy. The minor papilla was removed by snare electrocautery in all patients. A pancreatic stent was placed in the dorsal duct in patients with pancreas divisum as a prophylaxis for post-ERCP pancreatitis. Complications were assessed per consensus criteria.Main Outcome MeasurementsTo evaluate the technical success and safety of endoscopy for resection of minor papilla adenomas.ObservationsThree patients underwent endoscopic resection of minor papilla adenomas over a 12-month period. The first patient had minor papilla adenoma, the second had coexisting pancreas divisum anatomy, and the third had adenomatous involvement of both the major and minor papillas. Minor papilla resection was technically successful in all 3 patients, with dual major and minor papilla resection in 1 patient who had adenomatous changes at both sites. Although 2 patients experienced no complications, the patient with pancreas divisum developed mild post-ERCP pancreatitis. At a 12-month follow-up, there was no evidence of tumor recurrence in any of the 3 patients.LimitationSmall number of patients.ConclusionsIn experienced hands, endoscopic resection of the minor papilla is technically feasible, safe, and is associated with favorable clinical outcomes.