The first experience of intraductal radiofrequency ablation for a large adenoma of the major duodenal papilla with extended intraductal spread

Background. Due to the high frequency of malignancy, adenomas of the major duodenal papilla must be removed. At present, minimally invasive intraluminal endoscopic surgeries are increasingly being considered as an alternative to resection interventions, while MDP neoplasms with intraductal spread (types III and IV) are of particular difficulty in endoscopic treatment. With the advent of an instrument for intraductal RFA, the question of the possibility of treating patients with adenomas of MDP with intraductal spread has become topical. Clinical case. A 60-year-old patient underwent complex endoscopic treatment at the N Vishnevsky National Research Medical Center for Surgery about the adenoma of type IV MDP with extensive involvement of the duodenal wall and an extended intraductal component in the CBD. Results. In our observation, clinical success was achieved in the treatment of a patient with a large adenoma of type IV MDP. Combined endoscopic treatment included removal of the tumor by resection of the MDP and duodenal mucosa, as well as destruction of the intraductal component of the adenoma in the lumen of the CBD using intraductal RFA. The intervention was completed with the installation of a plastic stent in the MP and CBD in order to prevent the development of post-manipulation pancreatitis and cicatricial stricture of the CBD. Conclusion. With the help of such a combined approach, it was possible to carry out a radical removal of a neoplasm of the MDP, which is technically difficult for endoscopic techniques.