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A 72-year-old man, with known prostate cancer, was admitted to our endoscopic unit for further evaluation of an obstruction at major papilla level. Endoscopic cholangiopancreatography revealed a depressed-type carcinoma at the ampulla of Vater and dilation of both the common bile and pancreatic ducts without intraductal filling defects. Intraductal ultrasonography showed a hypoechoic mass limited to the ampulla of Vater. Endoscopic wire-guided ampullectomy was performed after informed consent was obtained. Histologic examination of the resected specimen showed a completely excised well-differentiated adenocarcinoma limited to the ampulla of Vater. Both accurate preoperative staging and proper histologic evaluation of the resected specimen seem to justify endoscopic treatment of early ampullary cancer by an experienced endoscopist.