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A 67-year-old Caucasian male was admitted to another institution with choledocholithiasis complicated by acute cholangitis. Endoscopic retrograde cholangiopancreatography (ERCP) showed a large duodenal subepithelial lesion fully covering the papilla, and a dilated common bile duct (CBD) with multiple filling defects. Sphincterotomy was performed and CBD stones were removed. The patient underwent laparoscopic cholecystectomy 2 weeks later. During the subsequent 6 months, he had multiple self-limited episodes of biliary pain. He was admitted twice for this symptom, and on both occasions he underwent ERCP with enlargement of the papillary opening and stone extraction. Abdominal computed tomography (▶Fig. 1), magnetic resonance cholangiopancreatography, and endoscopic ultrasonography documented a duodenal lipoma, but were otherwise unremarkable. The patient was then referred to our tertiary centre. During a multidisciplinary meeting, he was proposed for endoscopic therapy of the duodenal lipoma, as it was assumed that this was the cause of incomplete biliary drainage. ▶ Fig. 1 Abdominal computed tomography images. a, b A 14mm, homogeneous, duodenal lesion, with sharp margins and fat density (40–120 Hounsfield units) was identified. c The lesion did not present contrast enhancement.

The endoscopic loop-and-let-go technique for treatment of an exceedingly rare cause of recurrent biliary pain