AMPULLECTOMY, STONE REMOVAL FOLLOWED BY SNARE POLYPECTOMY OF LOWER INTRADUCTAL ADENOMA AND ABLATION BY ARGON PLASMA COAGULATION

Ampullary adenomas are pre cancerous lesions involving the papilla and are mainly asymptomatic.

A 70 year old male was diagnosed to have bile duct stones on MRCP, when presented with abdominal pain and altered LFT`s. Ampullary adenoma was noted on ERCP. Ampullectomy was done. Balloon sphincteroplasty was done and 2 stones were extracted from the dilated duct. Lower ductal adenoma was noted and this was removed by snare polypectomy. Argon plasma coagulation was done for the remnant lesions. Nasoendoscope direct cholangioscopy was done to confirm there is no further extension of biliary adenoma. 3 months later, tiny remnants were ablated (APC).