Optimal management of neoplastic diseases of the papilla of Vater is still controversially discussed. Until a few years ago, surgical resection or transduodenal local excision were routinely performed as definitive treatments. In order to decrease mortality and morbidity, investigators systematically started in the late 1980's to evaluate alternative methods, particularly following an endoscopic strategy. In recent years, endoscopic resection procedures (e.g., snare resection, piecemeal resection, thermal ablative techniques) proved to be feasible and safe alternatives, especially for benign neoplastic diseases of the papilla. The following review summarizes criteria for the selection of patients and describes endoscopic resection techniques. In addition, outcome concerning recurrence rates and complications of surgical and endoscopic resection procedures are evaluated.