Endoscopic snare excision for a major papilla tumor

Tumors of the duodenal papilla include hyperplasia, adenoma, carcinoma in adenoma and carcinoma. As the duodenal papilla has special anatomical characteristics and treatment involves major intervention and correct preoperative diagnosis. In patients with adenoma, or early carcinoma of the papilla, various endoscopic snare excision techniques are indicated for complete removal the tumor. Pancreatitis and cholangitis are major complications caused by endoscopic techniques. In the present study, endoscopic snare excision of the tumor located at the major papilla was carried out in two cases with early carcinoma or adenoma patients using a therapeutic duodenoscope, a spiral snare for the colon, and pure cutting current. The patients who underwent insertion of a 5-Fr pancreatic stent and a 7-Fr biliary stent inserted immediately after endoscopic tumor resection did not develop either pancreatitis nor cholangitis. This seems to be a safe technical method to prevent complications of endoscopic snare excision of the major papilla tumor.