Endoscopic snare papillectomy with biliary and pancreatic stent placement for tumors of the major duodenal papilla
| Autor: | Shigeru Kohno, Junji Irie, Yohei Mizuta, Kazuhiko Nakao, Masaki Yamakawa, Takuji Yamao, Hajime Isomoto |
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| Rok vydání: | 2009 |
| Předmět: |
Adult
Male Ampulla of Vater medicine.medical_specialty Pancreatic disease medicine.medical_treatment Common Bile Duct Neoplasms fluids and secretions Pancreatic tumor medicine Humans Duodenoscopy Aged Aged 80 and over medicine.diagnostic_test business.industry Stent Middle Aged biochemical phenomena metabolism and nutrition medicine.disease Surgery Endoscopy Major duodenal papilla Treatment Outcome Biliary tract Biliary Duct Stent Feasibility Studies Pancreatitis Female Stents business Follow-Up Studies |
| Zdroj: | Surgical Endoscopy. 24:119-124 |
| ISSN: | 1432-2218 0930-2794 |
| DOI: | 10.1007/s00464-009-0538-8 |
| Popis: | This study aimed to evaluate the feasibility, safety, and follow-up results of endoscopic papilletomy (ESP) with pancreatic and biliary duct stent placement for ampullary tumors. The therapeutic approach to benign ampullary tumors remains unsettled. The ESP procedure is a curative treatment option for benign papillary tumors, but ESP raises concerns about a relatively high risk for procedure-related complications such as pancreatitis. A pancreatic stent may protect against complications.Between September 2000 and June 2008, 36 patients with ampullary tumors confined to the mucosa and no intraductal tumor growth underwent ESP. The preprocedural diagnostic tools included endoscopic ultrasound, transpapillary intraductal ultrasound, and endoscopic retrograde cholangiopancreatography. Pancreatic and biliary stent placement was attempted if feasible. Endoscopic follow-up evaluation was conducted periodically as surveillance for recurrence.En bloc ESP was achieved for 94% of lesions with a median size of 14 mm. There were 26 adenomas including 4 high-grade intraepithelial neoplasias (HGINs), 5 carcinomas in adenoma, and 3 intramucosal cancers. Complete resections with tumor-free lateral and basal margins was achieved for 81% of the cases. During the median follow-up period of 14 months, there was one recurrent adenoma, which was successfully eradicated by a repeat ESP. A pancreatic stent was placed in 35 cases and a biliary stent in 29 cases. Mild acute pancreatitis and bleeding, managed endoscopically, occurred in 3 cases each (8%).The ESP procedure can be feasible for benign ampullary adenoma, HGIN, and noninvasive cancer without intraductal tumor growth. Prophylactic stent placement in the pancreatic and bile ducts may reduce procedure-related complications. |
| Databáze: | OpenAIRE |
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