Endoscopic papillectomy for the complete resection of a pedunculated intra-ampullary papillary-tubular neoplasm confined within a choledochocele.

A woman in her 60s presented with epigastric pain and was diagnosed with acute cholangitis caused by a papillary tumor based on laboratory findings and imaging studies. An endoscopic evaluation was subsequently planned. Endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography revealed a pedunculated or subpedunculated polypoid lesion within a choledochocele. Histopathological examination of a biopsy specimen confirmed the diagnosis of intra-ampullary papillary-tubular neoplasm (IAPN), and an endoscopic papillectomy (EP) was performed. Choledochoceles are associated with an increased risk of cholangiocarcinoma due to pancreatic juice reflux. Although endoscopic treatments such as sphincterotomy and papillectomy have been reported, to our knowledge, no previous cases have described a tumor confined entirely within a choledochocele that was completely resected via EP. We report a rare case of IAPN within a choledochocele that was successfully treated with en bloc resection using the EP technique.