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Adenomas can develop anywhere along the gastrointestinal tract. Herein we describe pancreatic ductal adenoma causing recurrent pancreatitis treated by endoscopic snare polypectomy. A 70-year-old white male with recurrent acute pancreatitis (index attack 5 years ago) was referred for endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) evaluation. The latest magnetic resonance scan showed a pancreatic ductal filling defect with ductal dilatation (●" Fig.1). Linear array EUS examination revealed a 1.5×1.6cm submucosal, mixed echogenic mass lesion causing upstream pancreatic ductal dilation. The common bile duct was of normal caliber with no filling defects. ERCP confirmed a bulging ampulla and pancreatogram (●" Fig.2) established the dilated pancreatic duct with an irregular, mobile filling defect. Following pulltype pancreatic sphincterotomy, balloon extraction exposed a floppy, exuberant, irregular, adenomatous appearing polyp arising from the inferior wall of the pancreatic duct (●" Fig.3). Standard snare polypectomy was carried out with blended current and a 5-Fr pancreatic ductal stent was placed (●" Video 1). Histological assessment of the resected specimen revealed a villous adenoma with focal high grade dysplasia (●" Fig.4). The patient continues to do well with no further episodes of pancreatitis. Pancreatic ductal polyps are rare with few case reports in the literature [1,2]. Clinical Fig.2 Fluoroscopic image at endoscopic retrograde cholangiopancreatography (ERCP) confirms the filling defect in a dilated pancreatic duct.

Recurrent pancreatitis caused by pancreatic ductal villous adenoma treated with endoscopic snare polypectomy