Adenomas of the minor papilla are difficult to diagnose and are uncommon. However, they are pre-malignant and require removal. Data on endoscopic papillectomy (EP) for removal of these lesions is limited. We aimed to evaluate the effectiveness, safety, and long-term outcomes of endoscopic minor papillectomy.

A retrospective analysis of endoscopic papillectomy (EP) procedures was conducted at a single tertiary center over a 164-month period to November 2024. Patients who underwent minor EP were included and descriptively compared with major EP cases to explore differences in clinical features, safety, and long-term follow-up.

Among 215 patients who underwent EP, 10 with minor papillary adenomas were included. Of the remaining 205 major papilla lesions, 162 were non-malignant adenomas and were used for descriptive comparison. Identification of minor papilla lesions was inconsistent: 3(30%) were referred as major papilla lesions, 3(30%) as duodenal polyps, and 4(40%) specifically as minor papilla lesions. The minor papilla cohort had a mean age of 67, with 6 patients (60%) being female. Most lesions were of sporadic origin (90%). Compared to major papillary adenomas, minor papillary lesions were similar in size (median 20 mm; p=0.256), and had a similar EP procedure time (69 min vs 60 min; p = 0.68). Adverse events were minimal: two patients (20%) had delayed bleeding not requiring intervention, and one (10%) had post-EP pancreatitis, comparable to major EP. Median follow-up was 22 months (IQR 6–33), with two recurrences, both managed successfully with cold avulsion with snare tip soft coagulation (CAST). Three cases with pancreatic divisum were resected successfully with minimal adverse events and no recurrence. No patients required surgery or developed malignancy during follow-up.

Minor papilla adenomas have similar characteristics as the major papilla. They can be safely and effectively removed endoscopically. Even in the setting of pancreatic divisum, adverse events are infrequent.