For papillary adenoma with heterogeneous hyperplasia, the traditional methods are pancreaticoduodenectomy or local resection of tumor in vater’s abdomen, both of which are highly invasive and have many complications. Transendoscopic duodenal papillotomy is a new technique in recent years, in which the tumor of the papilla is first removed endoscopically and then a pancreatic drain is placed to prevent the occurrence of pancreatitis. However, this treatment requires solid ERCP technique. If the papillary tumor is not successfully placed into the pancreatic duct stent after resection, the patient will have severe pancreatitis, which can be life-threatening, and the vater pot abdomen is rich in blood flow, which is very easy to complicate bleeding and requires high endoscopic hemostasis technique. Recently, a middle-aged female with duodenal papilla was admitted to the endoscopy center and successfully underwent minimally invasive endoscopic treatment. The gastrointestinal endoscopy ward discussed the patient carefully before the operation and perfected various examinations, especially the ultrasonic endoscopy, which clarified that the lesion was limited to the jugular abdomen and did not involve the pancreas and biliopancreatic duct, and the pathology was tubular adenoma with moderate atypical hyperplasia. After thorough preparation, Deputy Director Sun Siyu personally performed the surgery on the patient. The tumor was cut down very smoothly with clean margins and no bleeding, and the pancreatic duct was accurately placed and the patient returned to the ward. However, 4 hours after the patient returned to the ward, the patient suddenly appeared to vomit blood, and Director Sun decisively performed endoscopic examination on the patient, and found that a small arterial stump at the lower end of the incision margin had delayed bleeding and arterial ejection. The patient’s condition was stable after surgery and he is recovering well. The postoperative gross pathological return was consistent with the preoperative period. The success of this treatment marked a new level in pancreaticobiliary endoscopy in our hospital. Microscopic visualization of a large tumor in the duodenal papilla EUS showed a high echogenicity of the lesion, which did not involve the intestinal wall, pancreas and biliopancreatic duct, and the vater pot belly cavity was slightly dilated in a cystic pattern. The lesion was excised from the jugular abdomen without any problems. The isolated specimen was cauliflower-like and nearly 3 cm in diameter. A pancreatic drain was successfully placed A small arterial pulsatile bleeding occurred a few hours later The bleeding was successfully controlled with a metal clip.