Natural course of a case of adenocarcinoma of the duodenal papilla after endoscopic resection with long-term survival

An 89-year-old woman came to our hospital because of anemia. She was found to have a major duodenal papilla tumor by screening upper gastrointestinal endoscopy. The preoperative diagnosis by biopsy was adenoma. We performed endoscopic resection and the tumor was deeply resected. However, the final pathological diagnosis of the resected specimen was well-differentiated adenocarcinoma with positive margins. About 6 months later, local recurrence and lower bile duct invasion was confirmed on endoscopic retrograde cholangiopancreatography (ERCP) , but the patient and her family decided against re-resection. We performed repeated endoscopic plastic stenting for decompression of bile duct obstruction due to biliary invasion every 6 months, a total of 11 times, and eventually placed a fully covered metal stent. Subsequently, the patient was hospitalized because of pneumonia and sepsis and died on the 7 th day. Recently, reports of endoscopic resection for duodenal papilla carcinoma have increased and recurrence after resection has become a problem. However, studies describing the postoperative course are rare. Here, we have report the natural course of a case of recurrent adenocarcinoma of the major duodenal papilla after endoscopic resection with long-term survival of 6 years.