CHSJ

Curr Health Sci J, vol. 35, no. 2, 2009

Endoscopic Papillectomy into the Treatment of Neoplastic Lesions of Vater Papilla

[Original paper]

G. Ghidirim(1), I. Misin(1), V. Istrate(1), S. Cazacu(2)


(1)Department of Surgery “N. Anestiadi”, Hepato- Bilio-Pancreatic Surgery Laboratory, University of Medicine and Pharmacy "N. Testemitsanu", Chisinau, Moldova;
(2) Internal Medicine. Gastroenterology. Hepatology Department, University of Medicine and Pharmacy of Craiova, Gastroenterology Department – Emergency Hospital Craiova


Abstract:

Adenomas of the duodenal papilla are rare. The frequency of malignant adenomas is 15-30%. Villous adenoma is a premalignant lesion with the highest rate of transformation. Options for surgical treatment include endoscopic and ablation resection, transduodenal ampullectomy, duodeno-pancreatectomy. Aim: Evaluation of the efficacy and safety of endoscopic papillectomy for ampullary adenomas. Material and method: 12 patients were selected (F:M, 5:7, age range 37 - 68 years) with ampullary adenoma, treated by endoscopic papillectomy. Biliary sphincterotomy was performed in 6 cases; and pancreatic sphincterotomy was performed in 3 cases. Biliary stenting was performed in 2 cases; pancreatic stent was placed in 11 cases. Results: En bloc resection was performed in 8 cases, and piecemeal resection in 4 cases. Complete resection R0 was noted in 10 cases. Pathology examination has show: tubulo-villous adenoma (5 patients); villous adenoma (4 patients), tubular adenoma (2 cases), adenocarcinoma (one case). Complications were immediate: bleeding (2 cases) and pancreatitis (1 case). Follow-up endoscopy reveals no ductal stenosis or recurrence. Conclusion: Endoscopic papillectomy is a safe and well-tolerated alternative to surgical treatment of ampullary adenoma.


Keywords: ampullary adenoma, Vater papilla, endoscopic papillectomy, bleeding, pancreatitis, sphyncterotomy



Corresponding: Prof. G. Ghidirim, MD, PhD, Department of Surgery "N. Anestiadi", Hepato- BilioPancreatic Surgery Laboratory, University of Medicine and Pharmacy "N. Testemitsanu", Chisinau, Moldova


DOI 10.12865/CHSJ.35.02.02 - Download PDF
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