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Journal of Hepato-Biliary-Pancreatic Sciences

Published in:

01-03-2011 | Original article

Clinical impact of endoscopic papillectomy for benign–malignant borderline lesions of the major duodenal papilla

Authors: Megumi Harano, Shomei Ryozawa, Hirotoshi Iwano, Kumiko Taba, Manabu Sen-yo, Isao Sakaida

Published in: Journal of Hepato-Biliary-Pancreatic Sciences | Issue 2/2011

Abstract

Background and purpose

The present study retrospectively analyzed the clinical impact of endoscopic papillectomy on the selection of a treatment strategy for patients with benign–malignant borderline lesions of the major duodenal papilla.

Patients and methods

Between November 1995 and July 2009, 28 patients were selected for endoscopic papillectomy. The clinical impact of endoscopic papillectomy was assessed. Snare resection was performed in a radical fashion.

Results

An endoscopic papillectomy was technically feasible in all patients. En bloc excision was achieved in 22 cases (79%). The final histopathological diagnoses of the endoscopic specimen were 17 adenoma (61%), 7 carcinoma in adenoma (25%), and 4 adenocarcinoma (14%). Two out of the four adenocarcinoma cases were referred for surgery. The other two patients with negative margins have not experienced recurrences during the follow-up period. A residual tumor was detected in 1 out of 17 cases (6%) of adenoma and 2 out of 7 cases (29%) of carcinoma in adenoma.

Conclusions

Endoscopic papillectomy is therefore considered to be an effective treatment for patients with a benign–malignant borderline lesion of the major duodenal papilla. This method also has an important clinical impact because it provides an accurate diagnosis, aids in the selection of an appropriate treatment strategy, and reduces unnecessary surgery.

Rosenberg J, Welch JP, Pyrtek LI, Walker M, Trowbridge P. Benign villous adenomas of the ampulla of Vater. Cancer. 1986;58:1563–8.PubMedCrossRef

Yamaguchi K, Enjoji M. Carcinoma of the ampulla of Vater. A clinicopathologic study and pathologic staging of 109 cases of carcinoma and 5 cases of adenoma. Cancer. 1987;59:506–15.PubMedCrossRef

Scarpa A, Capelli P, Zamboni G, Oda T, Mukai K, Bonetti F, et al. Neoplasia of the ampulla of Vater. Ki-ras and p53 mutations. Am J Pathol. 1993;142:1163–72.PubMed

Stolte M, Pscherer C. Adenoma-carcinoma sequence in the papilla of Vater. Scand J Gastroenterol. 1996;31:376–82.PubMedCrossRef

Binmoeller KF, Boaventura S, Ramsperger K, Soehendra N. Endoscopic snare excision of benign adenomas of the papilla of Vater. Gastrointest Endosc. 1993;39:127–31.PubMedCrossRef

Zadorova A, Dvorak M, Hajer J. Endoscopic therapy of benign tumors of the papilla of Vater. Endoscopy. 2001;33:345–7.PubMedCrossRef

Desilets DJ, Dy RM, Ku PM, Hanson BL, Elton E, Mattia A, Howell DA. Endoscopic management of tumors of the major duodenal papilla: refined techniques to improve outcome and avoid complications. Gastrointest Endosc. 2001;54:202–8.PubMedCrossRef

Norton ID, Gostout CJ, Baron TH, Geller A, Petersen BT, Wiersema MJ. Safety and outcome of endoscopic snare excision of the major duodenal papilla. Gastrointest Endosc. 2002;56:239–43.PubMedCrossRef

Maguchi H, Takahashi K, Katanuma A, Hayashi T, Yoshida A. Indication of endoscopic papillectomy for tumors of the papilla of Vater and its problems. Dig Endosc. 2003;15(Suppl):S33–5.CrossRef

10.

Catalano MF, Linder JD, Chak A, Sivak MV, Raijman I, Geenen JE, et al. Endoscopic management of adenoma of the major duodenal papilla. Gastrointest Endosc. 2004;59:225–32.PubMedCrossRef

11.

Cheng CL, Sherman S, Fogel EL, McHenry L, Watkins JL, Fukushima T, et al. Endoscopic snare papillectomy for tumors of the duodenal papillae. Gastrointest Endosc. 2004;60:757–64.PubMedCrossRef

12.

Hirooka Y, Itoh A, Goto H. EUS/IDUS and endoscopic papillectomy. Dig Endosc. 2004;16:S176–7.CrossRef

13.

Bohnacker S, Soehendra N, Maguchi H, Chung JB, Howell DA. Endoscopic resection of benign tumors of the papilla of Vater. Endoscopy. 2006;38:521–5.PubMedCrossRef

14.

Bohnacker S, Seitz U, Nguyen D, Thonke F, Seewald S, deWeerth A, et al. Endoscopic resection of benign tumors of the duodenal papilla without and with intraductal growth. Gastrointest Endosc. 2005;62:551–60.PubMedCrossRef

15.

Han J, Kim MH. Endoscopic papillectomy for adenomas of the major duodenal papilla. Gastrointest Endosc. 2006;63:292–301.PubMedCrossRef

16.

The American Society for Gastrointestinal Endoscopy. The role of endoscopy in ampullary and duodenal adenomas. Gastrointest Endosc. 2006;64:849–54.CrossRef

17.

Aiura K, Hibi T, Handa K, Kojima M, Kitagawa Y. Endoscopic snare papillectomy for tumors of the major duodenal papilla. Dig Endosc. 2008;20:154–8.CrossRef

18.

Boix J, Lorenzo-Zuniga V, Moreno de Vega V, Domenech E, Gassull MA. Endoscopic resection of ampullary tumors: 12-year review of 21 cases. Surg Endosc. 2009;23:45–9.PubMedCrossRef

19.

Yamaguchi K, Enjoji M, Kitamura K. Endoscopic biopsy has limited accuracy in diagnosis of ampullary tumors. Gastrointest Endosc. 1990;36:588–92.PubMedCrossRef

20.

Menzel J, Poremba C, Dietl KH, Bocker W, Domschke W. Tumors of the papilla of Vater: inadequate diagnostic impact of endoscopic forceps biopsies taken prior to and following sphincterotomy. Ann Oncol. 1999;10:1227–31.PubMedCrossRef

21.

Fujita N, Noda Y, Kobayashi G, Kimura K, Ito K. Endoscopic papillectomy: is there room for this procedure in clinical practice? Dig Endosc. 2003;15:253–5.CrossRef

22.

Schlemper RJ, Riddell RH, Kato Y, Borchard F, Cooper HS, Dawsey SM, et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut. 2000;47:251–5.PubMedCrossRef

23.

Harewood GC, Pochron NL, Gostout CJ. Prospective, randomized, controlled trial of prophylactic pancreatic stent placement for endoscopic snare excision of the duodenal ampulla. Gastrointest Endosc. 2005;62:367–70.PubMedCrossRef

24.

Itoi T, Tsuji S, Sofuni A, Itokawa F, Kurihara T, Tsuchiya T, et al. A novel approach emphasizing preoperative margin enhancement of tumor of the major duodenal papilla with narrow-band imaging in comparison to indigo carmine chromoendoscopy. Gastrointest Endosc. 2009;69:136–41.PubMedCrossRef

Title: Clinical impact of endoscopic papillectomy for benign–malignant borderline lesions of the major duodenal papilla
Authors: Megumi Harano
Shomei Ryozawa
Hirotoshi Iwano
Kumiko Taba
Manabu Sen-yo
Isao Sakaida
Publication date: 01-03-2011
Publisher: Springer Japan
Published in: Journal of Hepato-Biliary-Pancreatic Sciences / Issue 2/2011
Print ISSN: 1868-6974
Electronic ISSN: 1868-6982
DOI: https://doi.org/10.1007/s00534-010-0327-8

At a glance: The STEP trials

Springer Medicine

Clinical impact of endoscopic papillectomy for benign–malignant borderline lesions of the major duodenal papilla

Abstract

Background and purpose

Patients and methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background and purpose

Patients and methods

Results

Conclusions

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