A two-step endoscopic method successfully removed a giant 60-millimeter tumor at the duodenal papilla in a 75-year-old patient with no complications and no recurrence during 12-month follow-up, according to a case report published in Medicine. The procedure involved removing most of the tumor in the first session to improve visibility, then removing the remaining tissue five days later. While this case demonstrates the technique is feasible, Gram Research analysis notes this is a single patient report requiring further study before widespread adoption.
Doctors in a case report described a new surgical technique for removing a very large tumor found near the opening where the pancreas connects to the small intestine. Instead of trying to remove the entire 60-millimeter tumor in one procedure, surgeons used a two-step approach: first removing most of the tumor to get a better view, then removing the remaining piece five days later. The patient recovered well with no complications during 12 months of follow-up. This case suggests the two-step method could be a safer option for patients with giant intestinal tumors that are difficult to remove all at once.
Key Statistics
A case report published in Medicine in 2026 described successful removal of a 60 by 50 millimeter giant tumor at the duodenal papilla using a novel two-step endoscopic method, with no complications and no recurrence observed during 12-month follow-up.
Endoscopic ultrasound in this case confirmed the tumor originated in the mucosal and submucosal layers without invasion of the bile duct or pancreatic duct, findings that indicated the tumor could be safely removed endoscopically.
Histopathology of the resected specimen revealed a villous-tubular adenoma with low-grade intraepithelial neoplasia and no adenomatous tissue at the cauterized margins, confirming complete tumor removal.
The Quick Take
- What they studied: Whether a new two-step surgical technique could safely remove a very large tumor located at the opening where the pancreas connects to the small intestine.
- Who participated: One 75-year-old female patient who had a giant tumor measuring about 60 by 50 millimeters (roughly the size of a large grape) blocking the duodenum, the first part of the small intestine.
- Key finding: The two-step endoscopic method successfully removed the entire tumor without complications, and the patient remained tumor-free for at least 12 months after treatment.
- What it means for you: This case suggests that patients with very large intestinal tumors may have a safer treatment option that avoids the risks of trying to remove everything in one difficult surgery. However, this is based on a single patient, so more research is needed before doctors widely adopt this approach.
The Research Details
This is a case report describing the medical care of one specific patient. A 75-year-old woman came to the hospital complaining of abdominal bloating that had lasted six months. Doctors used a camera inserted through the mouth to look inside her digestive system and found a giant tumor in the duodenum, the first section of the small intestine. The tumor was so large that doctors could not see its full size or shape in one viewing.
Doctors performed several imaging tests to understand the tumor better. They used ultrasound, CT scans, and tissue samples to confirm the tumor was not invasive and had not spread to nearby organs. Based on these findings, they decided to try a new two-step surgical approach rather than attempting to remove the entire tumor in one procedure.
In the first surgery, doctors removed most of the tumor using a technique called piecemeal resection, which means removing it in pieces. Five days later, they performed a second procedure to remove the remaining tumor tissue. After the second procedure, they placed small tubes called stents in the bile and pancreatic ducts to prevent swelling. Doctors then followed the patient for 12 months to check for any problems or tumor recurrence.
This approach matters because very large tumors in the duodenum are difficult to treat. When a tumor is too big to see completely in one procedure, surgeons struggle to remove all of it safely. By splitting the surgery into two steps, doctors could remove the bulk of the tumor first, which gave them a clearer view for the second procedure. This two-step method may reduce the risk of complications like bleeding or damage to nearby organs compared to trying to remove everything at once.
This is a single case report, which is the lowest level of medical evidence. It describes what happened with one patient, not a group of patients. While the outcome was successful, we cannot know if this method will work equally well for other patients or if it is truly better than other treatment options. The case does show that the two-step method is possible and safe in at least one patient, but doctors need to study many more patients before recommending this as standard treatment.
What the Results Show
The two-step endoscopic method successfully removed the entire 60 by 50 millimeter tumor without any serious complications. In the first procedure, doctors removed the bulk of the tumor in pieces, which improved their ability to see the remaining tissue. Five days later, in the second procedure, they removed the remaining tumor tissue using a technique called endoscopic mucosal resection, which involves injecting fluid under the tumor to lift it away from the underlying tissue before removal.
After the second procedure, doctors placed protective stents (small tubes) in the bile duct and pancreatic duct to prevent swelling and complications. The patient began eating a cold liquid diet the day after the second surgery and experienced no abdominal pain, bleeding, or fever during recovery.
Histology, the microscopic examination of the removed tissue, showed that the tumor was a villous-tubular adenoma with low-grade intraepithelial neoplasia, a type of precancerous growth. Importantly, no cancer cells were found at the edges of the removed tissue, indicating that the entire tumor had been removed. During 12 months of follow-up, the patient showed no signs of tumor recurrence.
The imaging tests performed before surgery provided important information about the tumor. Contrast-enhanced CT scans showed the tumor was 65 by 35 millimeters and was located inside the intestinal lining. Endoscopic ultrasound confirmed that the tumor originated in the mucosal and submucosal layers, the innermost layers of the intestinal wall, and that it had not invaded the bile duct or pancreatic duct. These findings were crucial because they indicated the tumor could be removed endoscopically without damaging these important structures.
The authors note that reports of endoscopic treatment for large duodenal tumors are rare in the medical literature. Most previous cases describe smaller tumors or tumors in different locations. This case appears to be the first report of the two-step endoscopic method for a giant lesion at the major duodenal papilla, the opening where the pancreas connects to the intestine. The two-step approach differs from standard endoscopic papillectomy, which typically removes the entire tumor in a single procedure, but may be necessary when the tumor is too large for safe single-session removal.
This is a single case report involving only one patient, so the findings cannot be generalized to other patients. We do not know if the two-step method will work as well for other patients with similar tumors or if it is truly superior to other treatment approaches. The patient was followed for only 12 months, so long-term outcomes beyond this period are unknown. Additionally, without comparing this method to other treatment options in a controlled study, we cannot determine if it offers advantages over alternative approaches. The authors themselves state that further experience with more patients is needed before doctors can establish consensus on the best way to treat such large lesions.
The Bottom Line
Based on this single case, the two-step endoscopic method appears to be a safe and effective option for removing very large tumors at the duodenal papilla when single-session removal is not feasible. However, this recommendation has low confidence because it is based on only one patient. Patients with similar tumors should discuss this approach with their gastroenterologist or surgeon, but should understand that this is a newer technique that requires further study. The decision to use this method should be made on an individual basis after careful evaluation by experienced specialists.
This finding is most relevant to patients with large tumors at the duodenal papilla and to gastroenterologists and surgeons who treat such patients. Patients with smaller tumors or tumors in other locations may not benefit from this specific two-step approach. People with a family history of intestinal tumors or those with genetic syndromes that increase cancer risk may want to discuss preventive screening with their doctors.
In this case, the patient recovered quickly, beginning a liquid diet the day after the second procedure and experiencing no complications. However, recovery time may vary depending on the individual patient, the size and location of the tumor, and any complications that arise. Patients should expect to follow their doctor’s dietary recommendations for several weeks after the procedure and attend follow-up appointments to monitor for recurrence.
Frequently Asked Questions
What is the two-step method for removing duodenal tumors?
The two-step method involves removing the bulk of a large tumor in the first endoscopic procedure to improve visibility, then removing the remaining tissue in a second procedure five days later. This approach may be safer than attempting to remove very large tumors in a single session.
How long does recovery take after this two-step tumor removal procedure?
In the reported case, the patient began a cold liquid diet the day after the second procedure and experienced no complications. Recovery time varies by individual, but patients typically follow dietary restrictions for several weeks and attend regular follow-up appointments to monitor for recurrence.
Can this two-step endoscopic method be used for all large intestinal tumors?
This method was developed specifically for large tumors at the duodenal papilla, the opening where the pancreas connects to the intestine. Whether it applies to other types or locations of intestinal tumors requires further research, as this is based on a single case report.
What are the risks of the two-step endoscopic tumor removal?
Potential risks of endoscopic procedures include bleeding, infection, and perforation of the intestinal wall. In this case, no complications occurred, but risks vary by patient and tumor characteristics. Discuss specific risks with your gastroenterologist before the procedure.
How often do patients need follow-up endoscopy after this procedure?
The reported patient had no recurrence during 12 months of follow-up, but long-term follow-up schedules depend on individual factors. Your gastroenterologist will recommend appropriate screening intervals, typically every 6 to 12 months initially, to monitor for tumor recurrence.
Want to Apply This Research?
- If you have undergone this procedure, track your daily symptoms including abdominal pain, bloating, nausea, and any changes in bowel movements. Record these in a symptom log with dates and severity ratings from 1 to 10, and share this information with your doctor at follow-up appointments.
- After this procedure, follow your doctor’s dietary recommendations carefully, starting with cold liquids and gradually advancing to soft foods as tolerated. Set reminders for your follow-up appointments and endoscopy screenings, which are important to check for tumor recurrence.
- Maintain a long-term follow-up schedule with your gastroenterologist, typically including endoscopy examinations at regular intervals (such as every 6 to 12 months initially) to monitor for any signs of tumor recurrence. Keep detailed records of all imaging tests, biopsies, and endoscopy findings to track your progress over time.
This case report describes the successful treatment of one patient and should not be considered a recommendation for all patients with similar tumors. The two-step endoscopic method is a newer technique that requires further research and clinical experience before becoming standard treatment. Patients with duodenal tumors should consult with experienced gastroenterologists or surgeons to determine the most appropriate treatment for their individual situation. This information is for educational purposes only and does not replace professional medical advice. Always discuss treatment options, risks, and benefits with your healthcare provider before making any medical decisions.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.