A case of ampullary carcinoma successfully managed with endoscopic snare resection

Pancreaticoduodenectomy and transduodenal ampullectomy have been the procedures of choice for ampullary cancer in most patients. However, for patients with small ampullary neoplasms or who are unfit for laparotomy or refuse open surgical operations, endoscopic snare ampullectomy may be appropriate. We report here a case of ampullary carcinoma in which endoscopic snare ampullectomy was performed successfully, with long-term survival. The patient was a 77-year-old man with a 30-year history of ulcerative colitis, who presented with epigastric pain and fever. He had a history of four laparotomies. Laboratory studies showed a mild elevation in alkaline phosphatase, serum aspartate aminotransferase, gamma glutamyltransferase, and C-reactive protein values. At endoscopic retrograde cholangiopancreatography, the ampulla was prominent, with granulomatous proliferation. The common bile duct was dilated to approximately 25 mm in diameter. Biopsy specimens of the ampulla showed a well-differentiated adenocarcinoma. Because of extensive adhesions of the peritoneal cavity due to the prior four laparotomies and the patient's refusal of surgery, endoscopic snare ampullectomy was performed. Ten days after the ampullectomy, the patient was discharged from the hospital without any complication. The patient has been well for the 4 years since then, without recurrence of the tumor or jaundice. Endoscopic snare ampullectomy may be considered as a viable alternative to surgery in patients with small ampullary tumors who are unfit for surgery or who prefer a nonsurgical approach.