More Than Skin Deep: Beneath the Surface of a Routine Ampullary Adenoma

Abstract

Question: A 67-year-old man with a history of Barrett’s esophagus was undergoing surveillance endoscopy, which noted a prominent, thickened major duodenal papilla. Subsequent biopsies revealed fragments of adenoma without high-grade dysplasia and the patient was referred for further management. Direct endoscopy again revealed a prominent ampulla with a nodular surface (Figure A). Endoscopic ultrasound examination showed a dilated common bile duct measuring 7 mm and an unremarkable gallbladder. Endoscopic ultrasound examination of the major papilla did not reveal any obvious extension of the adenomatous process into the distal common bile duct or the main pancreatic duct (Figure B).