Familial adenomatous polyposis syndromes are known to be associated with colon cancer, thus colectomy is recommended prophylactically. duodenal carcinoma is now the leading cause of cancer-related death in these patients. The typical treatment approaches to premalignant duodenal adenmomas have involved the extremes of transduodenal excision or pancreaticoduodenectomy. Herein depicted is an alternative approach where complete resection of the high risk adenomous polyps of the duodenum/periampullary region are excised without pancreatic resection. This is our current preferred approach to Spigelman stage III and IV patients.