Intraluminal endoscopic complex approach in the treatment of a patient with adenoma of the major duodenal papilla, choledocholithiasis and stricture of the terminal common bile duct

Abstract

Introduction. Adenomas of the major duodenal papilla are benign neoplasms, but due to their high tendency to malignancy, they must be removed. At present, minimally invasive methods of operations are increasingly being considered as an alternative to surgical interventions, while cases of a combination of a neoplasm of the major duodenal papilla with choledocholithiasis and bile duct strictures are of particular difficulty in endoscopic treatment. Clinical case. A 62-year-old patient underwent complex endoscopic treatment at the Vishnevsky National Research Medical Center for Surgery about adenoma of the major duodenal papilla type IV, extending to the walls of the duodenum and the terminal section of the common bile duct, in combination with choledocholithiasis and cicatricial stricture of the common bile duct. Results. The patient successfully applied a complex approach of minimally invasive treatment in the amount of endoscopic lithoextraction, fragmentary removal of adenoma of the major duodenal papilla with intraductal high-frequency electrosurgical ablation of residual adenomatous tissue and subsequent staged biliary stenting for cicatricial stricture of the common bile duct, as well as stenting of the main pancreatic duct to prevent post-manipulation pancreatitis. Discussion. An integrated approach in the treatment of a patient with adenoma of the major duodenal papilla IV, choledocholithiasis and stricture of the common bile duct, made it possible to achieve clinical success in the absence of complications and the need for long-term rehabilitation.