Fish-Mouth Papilla

A 53-year-old man presented with postprandial epigastric pain and weight loss for 2 months. He had no significant medical or family history. Physical examination was normal and the laboratory results were unremarkable. We performed an upper endoscopy, which showed a normal stomach and duodenum. However, the major papilla (Figure A) had an unusual appearance. We examined the patient using a duodenoscope and observed a fish-mouth–like papilla extruding thick mucus (Supplementary Video 1). The fish-mouth appearance of papilla, although not always present (prevalence, 50%), is pathognomonic and specific (91%) for intraductal papillary mucinous neoplasm (IPMN) of the pancreas.

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