Post written by Elena De Cristofaro, MD, PhD, from the Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy, and Mathieu Pioche, MD, PhD, from the Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.

We report a rare case of a type III choledochocele with a polypoid lesion suspicious for dysplasia. Initial EUS-guided EMR enabled targeted biopsies and confirmed low-grade dysplasia. Given the risk of malignant progression, a complete ampullectomy was performed, with successful en bloc resection of the papilla and choledochocele base. No adverse events occurred, and final histology confirmed low-grade dysplasia.

This video demonstrates a stepwise and minimally invasive approach to a rare biliary lesion, highlighting the role of EUS-guided EMR in diagnosis and justification for complete resection. It also shows a practical alternative to cholangioscopy when biliary access is infeasible.

Endoscopists can consider EUS-guided EMR to obtain diagnostic tissue when conventional ERCP is not possible. This approach provides a time-saving and cost-effective alternative in rare cases such as choledochocele with suspected dysplasia and can guide further therapeutic steps.

Todani III choledochocele with a polypoid-like lesion within the collection revealed at EUS.

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