Endoscopic snare papillectomy in patients with familial adenomatous polyposis and ampullary adenoma.
Endoscopy
; 29(7): 685-8, 1997 Sep.
Article
em En
| MEDLINE
| ID: mdl-9360885
ABSTRACT
The optimal treatment of adenomas of the papilla of Vater has still not been definitively established, and the endoscopic excision of such lesions has received little attention in the literature. We report here the cases of two patients with familial adenomatous polyposis, in whom ampullary adenomas measuring 8 and 20 mm, respectively, were treated using one-piece snare excision of the lesion together with the papilla (snare papillectomy), followed by temporary biliopancreatic drainage. Procedure-related complications were an oozing-type hemorrhage and a mild pancreatitis, easily controlled by conservative measures. During the 18-month follow-up, one patient had a small recurrence that was successfully retreated. Further endoscopic and biopsy controls were negative. Although limited, our experience and the data in the literature indicate that snare papillectomy is a viable alternative to surgery for benign ampullary adenomas. Excising both the lesion and the papilla offers good oncological debridement and, unlike laser or thermal ablation, allows a complete histological evaluation of the pathological tissue. However, snare papillectomy should always be associated with temporary biliopancreatic drainage before or after the procedure in order to prevent ductal obstruction and serious pancreatitis. This maneuver should therefore preferably be performed by experienced endoscopists trained in therapeutic endoscopic retrograde cholangiopancreatography and hemostatic techniques.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Ampola Hepatopancreática
/
Adenoma Viloso
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Neoplasias do Ducto Colédoco
/
Polipose Adenomatosa do Colo
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Endoscopia
Limite:
Adult
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Female
/
Humans
/
Male
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Middle aged
Idioma:
En
Revista:
Endoscopy
Ano de publicação:
1997
Tipo de documento:
Article