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Ampullary Adenoma Treated by Endoscopic Double-Snare Retracting Papillectomy.

Soma H, Miyata N, Hozawa S, Higuchi H, Yamagishi Y, Nakamura Y, Saeki K, Kameyama K, Masugi Y, Yahagi N, Kanai T - Gut Liver (2015)

Bottom Line: En bloc resection by double-snare retracting papillectomy was successfully performed for all lesions (median size, 12.3 mm), comprising six tubular adenomas, one tubulovillous adenoma, three cases of epithelial atypia, one hamartomatous polyp, and one case of duodenitis with regenerative change.Significant hemorrhage and pancreatitis were observed in one case after EP.Double-snare retracting papillectomy is effective and feasible for treating lesions of the major duodenal papilla.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.

ABSTRACT
We report herein improved methods for the safe and successful completion of endoscopic papillectomy (EP). Between January 2008 and November 2011, 12 patients underwent double-snare retracting papillectomy for the treatment of lesions of the major duodenal papilla. The main outcomes were en bloc resection rates, pathological findings, and adverse events. All of the patients (mean age, 60.1 years; range, 38 to 80 years) were diagnosed with ampullary adenoma by endoscopic forceps biopsies prior to endoscopic snare papillectomy. En bloc resection by double-snare retracting papillectomy was successfully performed for all lesions (median size, 12.3 mm), comprising six tubular adenomas, one tubulovillous adenoma, three cases of epithelial atypia, one hamartomatous polyp, and one case of duodenitis with regenerative change. Significant hemorrhage and pancreatitis were observed in one case after EP. Adenoma recurrence occurred in three patients during follow-up (median, 28.5 months) at a mean interval of 2 months postoperatively (range, 1 to 3 months). No serious adverse events were observed. Double-snare retracting papillectomy is effective and feasible for treating lesions of the major duodenal papilla. Further treatment experience, including a single-arm phase II study, needs to be accumulated before conducting a randomized controlled study.

No MeSH data available.


Related in: MedlinePlus

Presentation of ampullary tumor and endoscopic resection procedures (A, C, E) and histological findings of a resected tumor specimen (B). (A) Endoscopic findings of the ampullary tumor. A 2-cm exposed reddish tumor was identified in the papilla of Vater. (B) Endoscopic ultrasonography revealed that the ampullary tumor had not invaded the duodenum, pancreas, terminal common bile duct, or main pancreatic duct. (C) Endoscopic double-snare papillectomy was performed. After grasping and pulling the tumor with the pulling snare, the tumor was safely and easily grasped by the cutting snare. (D) Histological examination demonstrated tubular adenoma with moderate to severe dysplasia. No lymphatic invasion or vascular involvement was identified (×200). (E) Endoscopy of the ampullary portion of the duodenum following endoscopic papillectomy revealed no neoplastic lesions.
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f1-gnl-09-689: Presentation of ampullary tumor and endoscopic resection procedures (A, C, E) and histological findings of a resected tumor specimen (B). (A) Endoscopic findings of the ampullary tumor. A 2-cm exposed reddish tumor was identified in the papilla of Vater. (B) Endoscopic ultrasonography revealed that the ampullary tumor had not invaded the duodenum, pancreas, terminal common bile duct, or main pancreatic duct. (C) Endoscopic double-snare papillectomy was performed. After grasping and pulling the tumor with the pulling snare, the tumor was safely and easily grasped by the cutting snare. (D) Histological examination demonstrated tubular adenoma with moderate to severe dysplasia. No lymphatic invasion or vascular involvement was identified (×200). (E) Endoscopy of the ampullary portion of the duodenum following endoscopic papillectomy revealed no neoplastic lesions.

Mentions: A 63-year-old man was admitted to our department for the evaluation of an ampullary mass, detected by an endoscopy that was performed for screening purposes at a general hospital. He had no significant past medical or family history. The patient was asymptomatic, and no abnormal signs were evident upon physical examination. Laboratory data also showed no abnormalities. Computed tomography and magnetic resonance imaging revealed a 2-cm mass in the descending part of the duodenum. Duodenoscopy revealed a 2-cm-diameter exposed reddish mass in the papilla of Vater (Fig. 1A). Biopsy showed atypical cells. EUS and ERCP revealed a 20-mm hypoechoic mass in the papilla of Vater without invasion of the duodenum, pancreas, bile duct terminus, or main pancreatic duct terminus (Fig. 1B). The lesion was therefore considered eligible for EP. Endoscopic double-snare papillectomy was performed. By grasping and pulling the tumor with the pulling snare, the tumor was safely and easily grasped with the cutting snare (Fig. 1C). En bloc papillectomy was performed with a bipolar electrosurgical cutting current. A stent was placed in the pancreatic duct, and a nasobiliary drainage tube was placed in the bile duct. There were no adverse events. Neither macro- nor microscopic tumor recurrence was observed. The resected specimen consisted of a whitish exophytic tumor, 20×9.6 mm in size, in the ampulla of Vater. Histological examination verified tubular adenoma with moderate to severe dysplasia (Fig. 1D). Follow-up endoscopy with biopsy was performed at 3 and 6 months postoperatively and every 6 months thereafter. However, no recurrence was observed after 48 months of follow-up (Fig. 1E).


Ampullary Adenoma Treated by Endoscopic Double-Snare Retracting Papillectomy.

Soma H, Miyata N, Hozawa S, Higuchi H, Yamagishi Y, Nakamura Y, Saeki K, Kameyama K, Masugi Y, Yahagi N, Kanai T - Gut Liver (2015)

Presentation of ampullary tumor and endoscopic resection procedures (A, C, E) and histological findings of a resected tumor specimen (B). (A) Endoscopic findings of the ampullary tumor. A 2-cm exposed reddish tumor was identified in the papilla of Vater. (B) Endoscopic ultrasonography revealed that the ampullary tumor had not invaded the duodenum, pancreas, terminal common bile duct, or main pancreatic duct. (C) Endoscopic double-snare papillectomy was performed. After grasping and pulling the tumor with the pulling snare, the tumor was safely and easily grasped by the cutting snare. (D) Histological examination demonstrated tubular adenoma with moderate to severe dysplasia. No lymphatic invasion or vascular involvement was identified (×200). (E) Endoscopy of the ampullary portion of the duodenum following endoscopic papillectomy revealed no neoplastic lesions.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4562789&req=5

f1-gnl-09-689: Presentation of ampullary tumor and endoscopic resection procedures (A, C, E) and histological findings of a resected tumor specimen (B). (A) Endoscopic findings of the ampullary tumor. A 2-cm exposed reddish tumor was identified in the papilla of Vater. (B) Endoscopic ultrasonography revealed that the ampullary tumor had not invaded the duodenum, pancreas, terminal common bile duct, or main pancreatic duct. (C) Endoscopic double-snare papillectomy was performed. After grasping and pulling the tumor with the pulling snare, the tumor was safely and easily grasped by the cutting snare. (D) Histological examination demonstrated tubular adenoma with moderate to severe dysplasia. No lymphatic invasion or vascular involvement was identified (×200). (E) Endoscopy of the ampullary portion of the duodenum following endoscopic papillectomy revealed no neoplastic lesions.
Mentions: A 63-year-old man was admitted to our department for the evaluation of an ampullary mass, detected by an endoscopy that was performed for screening purposes at a general hospital. He had no significant past medical or family history. The patient was asymptomatic, and no abnormal signs were evident upon physical examination. Laboratory data also showed no abnormalities. Computed tomography and magnetic resonance imaging revealed a 2-cm mass in the descending part of the duodenum. Duodenoscopy revealed a 2-cm-diameter exposed reddish mass in the papilla of Vater (Fig. 1A). Biopsy showed atypical cells. EUS and ERCP revealed a 20-mm hypoechoic mass in the papilla of Vater without invasion of the duodenum, pancreas, bile duct terminus, or main pancreatic duct terminus (Fig. 1B). The lesion was therefore considered eligible for EP. Endoscopic double-snare papillectomy was performed. By grasping and pulling the tumor with the pulling snare, the tumor was safely and easily grasped with the cutting snare (Fig. 1C). En bloc papillectomy was performed with a bipolar electrosurgical cutting current. A stent was placed in the pancreatic duct, and a nasobiliary drainage tube was placed in the bile duct. There were no adverse events. Neither macro- nor microscopic tumor recurrence was observed. The resected specimen consisted of a whitish exophytic tumor, 20×9.6 mm in size, in the ampulla of Vater. Histological examination verified tubular adenoma with moderate to severe dysplasia (Fig. 1D). Follow-up endoscopy with biopsy was performed at 3 and 6 months postoperatively and every 6 months thereafter. However, no recurrence was observed after 48 months of follow-up (Fig. 1E).

Bottom Line: En bloc resection by double-snare retracting papillectomy was successfully performed for all lesions (median size, 12.3 mm), comprising six tubular adenomas, one tubulovillous adenoma, three cases of epithelial atypia, one hamartomatous polyp, and one case of duodenitis with regenerative change.Significant hemorrhage and pancreatitis were observed in one case after EP.Double-snare retracting papillectomy is effective and feasible for treating lesions of the major duodenal papilla.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.

ABSTRACT
We report herein improved methods for the safe and successful completion of endoscopic papillectomy (EP). Between January 2008 and November 2011, 12 patients underwent double-snare retracting papillectomy for the treatment of lesions of the major duodenal papilla. The main outcomes were en bloc resection rates, pathological findings, and adverse events. All of the patients (mean age, 60.1 years; range, 38 to 80 years) were diagnosed with ampullary adenoma by endoscopic forceps biopsies prior to endoscopic snare papillectomy. En bloc resection by double-snare retracting papillectomy was successfully performed for all lesions (median size, 12.3 mm), comprising six tubular adenomas, one tubulovillous adenoma, three cases of epithelial atypia, one hamartomatous polyp, and one case of duodenitis with regenerative change. Significant hemorrhage and pancreatitis were observed in one case after EP. Adenoma recurrence occurred in three patients during follow-up (median, 28.5 months) at a mean interval of 2 months postoperatively (range, 1 to 3 months). No serious adverse events were observed. Double-snare retracting papillectomy is effective and feasible for treating lesions of the major duodenal papilla. Further treatment experience, including a single-arm phase II study, needs to be accumulated before conducting a randomized controlled study.

No MeSH data available.


Related in: MedlinePlus