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

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.