Endoscopic snare polypectomy of a periampullary neoplasm

A 65-year old man presented with a six-month history of loss of appetite. Clinical examination was unremarkable. Initial endoscopy was reported to be normal. Ultrasound scan of the abdomen showed a dilated common bile duct with no gall bladder calculi. Serum alkaline phosphatase was raised (630.2 U/L). Duodenoscopy with a side-viewing scope (TJF-160R Olympus) revealed a periampullary growth hanging in to the duodenal lumen occluding the ampulla (Figure 1). Endoscopic snare polypectomy was performed. Free drainage of bile was observed after the polypectomy (Figure 2). Histology showed a villous adenoma with moderate dysplasia. Excision margins were clear. Repeat endoscopic retrograde cholangio pancreaticogram after Endoscopic snare polypectomy of a periampullary neoplasm G Kavinda Rajapakse1, ASD Liyanage2 and Mohan de Silva3