Endoscopic papillectomy for an ampullary neuroendocrine tumor

Ampullary neuroendocrine tumors (NETs) are extremely rare, have a high rate of transmural invasion and lymph node metastasis, and are generally recommended for surgery. In contrast, endoscopic papillectomy (EP) for ampullary NET, a low-grade type within the submucosal layer, is feasible and useful to avoid surgery. However, EP for ampullary NET is controversial, there are no consensus guidelines, and international recommendations are lacking. We present the case of a 60-year-old man with an ampullary NET who was successfully treated with EP via a hexagonal snare. Prior to EP, endoscopic ultrasonography, magnetic resonance cholangiopancreatography, and intraductal ultrasonography in endoscopic retrograde cholangiopancreatography were performed to assess for ductal infiltration of the NET. The specimen revealed a low-grade NET measuring 1.0 × 0.8 × 0.7 cm without venous or lymphatic infiltration, which was negative for horizontal and vertical margins. No recurrence was observed over a 12-month follow-up.