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CC BY 4.0 · Endoscopy 2025; 57(S 01): E975-E976
DOI: 10.1055/a-2665-7633
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Endoscopic retrograde direct cholangioscopy combined with endoscopic papillectomy in treatment of duodenal papillary adenoma

Authors

  • Shan-Shan Hu‡

    1   Department of Gastroenterology and Hepatology, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China

  • Hong Shen‡

    1   Department of Gastroenterology and Hepatology, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China

  • Yun-Chao Yang

    1   Department of Gastroenterology and Hepatology, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China

  • Jie Hou

    1   Department of Gastroenterology and Hepatology, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China

  • Wei-Hui Liu 

    1   Department of Gastroenterology and Hepatology, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China

Supported by: The Program for Sichuan Medical and Health Care Promotion Institute No. KY2023SJ0232
Supported by: Department of Science & Technology Department of Sichuan Province No. 2024YFFK0220
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Given the high risk of malignant transformation in duodenal papillary adenomas, timely endoscopic resection is critical [1] [2]. The conventional procedure involves snare resection followed by placement of biliary and pancreatic duct stents under fluoroscopic guidance to ensure drainage. However, conventional radiographic methods cannot assess invasion at the terminal ends of the biliary and pancreatic ducts, and in some cases, cannulation of these ducts may fail. To address these issues during endoscopic procedures, we apply endoscopic retrograde direct cholangioscopy (ERDC) [3] [4], a technique that we developed to allow complete visual resection of duodenal papillary adenomas without fluoroscopic assistance.

A female patient presented with a duodenal papillary adenoma. Complete resection was successfully achieved using snare polypectomy ([Fig. 1]), with prophylactic application of hemostatic clips to the resection site to minimize the risk of delayed bleeding ([Fig. 2]). We then employed a conical transparent cap-fitted cholangioscope to enable direct visualization during biliary and pancreatic duct cannulation. Subsequently, the distal ends of the common bile duct and pancreatic duct were examined under direct cholangioscopic vision to exclude residual tumor ([Fig. 3]), followed by placement of plastic stents ([Fig. 4]). Histopathological analysis confirmed a tubulovillous adenoma with clear basal and lateral margins ([Fig. 5]). The patient recovered well without complications and was discharged uneventfully ([Video 1]).

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Fig. 1 Endoscopic resection of a duodenal papillary adenoma. a Duodenal papillary adenoma. b Snare resection of the lesion. c Postoperative wound.
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Fig. 2 Endoscopic clip closure of the distal part of the surgical wound.
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Fig. 3 Endoscopic retrograde direct cholangioscopy (ERDC) technology for direct visual inspection of biliary and pancreatic ducts. a A conical transparent cap was installed at the distal end of the cholangioscope. b ERDC confirmed that there was no residual tumor in the bile duct. c There was no residual tumor in the pancreatic duct orifice under direct vision.
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Fig. 4 Indwelling biliary and pancreatic duct stents.
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Fig. 5 Postoperative specimen was fixed on a foam panel.
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The endoscopic retrograde direct cholangioscopy technique can not only determine whether there is residual tumor in the biliary and pancreatic ducts but also ensure the effectiveness of biliary and pancreatic stent placement.Video 1

This case demonstrates that in specific patient populations, such as those with duodenal papillary adenoma, including pregnant women and children, the ERDC technique can be utilized to achieve complete radiation-free endoscopic treatment, thereby avoiding radiation exposure. The radiation-free papillary resection procedure is safe and effective. The ERDC technique can not only determine whether there is residual tumor in the biliary and pancreatic ducts but also ensure the effectiveness of biliary and pancreatic stent placement.

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Publication History

Article published online:
27 August 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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