Detection of major duodenal papilla using full-spectrum endoscopy:a randomized controlled trial / 中华消化内镜杂志

Objective To evaluate the efficiency and safety of full-spectrum endoscopy for detection of major duodenal papilla. Methods Patients underwent painless gastroscopy in Chinese PLA General Hospital from March 2017 to December 2017 were enrolled and randomly divided into two groups according to random number method. The group A underwent conventional gastroscopy, and the group B underwent full-spectrum endoscopy. The detection rate of major duodenal papilla was calculated and compared between the two groups. Results A total of 100 patients were recruited in the study, including 51 in the group A and 49 in the group B. The whole detection rate of major duodenal papilla of the group B was higher than that of the group A [79. 59％ (39/49) VS 41. 18％ (21/51), χ2 =15. 366, P=0. 000]. There was no statistical difference on the whole plus partial detection rate of major duodenal papilla between the two groups [100. 00％ (49/49) VS 92. 16％ (47/51), χ2=2. 221, P=0. 136]. All patients completed endoscopy examination succesfully without bleeding, peforation or death. Conclusion With the broad view-field, full-spectrum endoscopy is useful to improve the efficiency and safety in detection of major duodenal papilla.

Distance Between Major And Minor Duodenal Papilla From Pylorus: A Cadaveric Study

Introduction: Without the knowledge of the normal pattern of the duct system and its variations, a radiologistcan’t interpret an Endoscopic Retrograde Cholangiopancreatography (ERCP) picture. So it becomes important tostudy the anatomy of pancreatic ducts, their relation to each other, to common bile duct and to duodenum in theavailable human cadavers. The present paper is about the study of distance between minor and major duodenalpapilla from pylorus which was carried out on 96 cadaveric specimens of human duodeno-pancreas. To visualiseand to see distance between minor and major duodenal papillae is necessary for the endoscopist who aims toperform the dilation, stenting, or papillotomy of the minor papilla.Materials and Methods: The study was conducted in 96 (64 male and 32 female) cadavers. Major and minorduodenal papillae were visualized through eosin dye installation in both common bile duct and the accessorypancreatic duct. The measurement of distance between the duodenal papillae and to pylorus was done in cm.Results: In the present work, the mean ± SD of the Distance between pylorus to MAP is 8.05 ± 1.71 cm, pylorus toMIP is 6.19 ± 1.49 cm, the major to minor duodenal papilla was on an average 2.02 ± 0.40 cm, these distanceswere more in males as compared to females. But the size of Orifice of MAP in specimens is 7.25 ± 1.25 mm morein females as compared to males.Conclusion: The length of the duct shows sexual dimorphism; the length being more in males than females.

Efficacy of endoscopic papillectomy for tumors of major duodenal papilla and literature review / 中国内镜杂志

Objective To evaluate and analyze the efficacy and safety of endoscopic papillectomy for tumors of major duodenal papilla. Methods The clinical data of three patients with tumors of major duodenal papilla who were treated by endoscopic papillectomy were retrospectively reviewed, and the clinical outcome was summarized. Results The success rate of endoscopic papillectomy was 100.0% (3/3), and the complete resection was 100.0% (3/3). No short-term complication occurred in 3 cases. The recurrence rate was 0.0% (0/3). Conclusion Endoscopic papillectomy is an effective method for treating tumors of major duodenal papilla.

Endoscopic Papillectomy for Synchronous Major and Minor Duodenal Papilla Neuroendocrine Tumors / 대한소화기학회지

Neuroendocrine tumor (NET) of the major duodenal papilla is a rare occurrence. However, that of the minor duodenal papilla is even rarer. To date, only a few cases have been reported. Herein, we present a rare case of NETs detected at the major and minor duodenal papilla synchronously, which were successfully treated with endoscopic papillectomy without procedure-related complication. To the best of our knowledge, this is the first report of this kind in the world. Photomicrograph of the biopsy specimen stained immunohistochemically for synaptophysin showed a positive reaction of tumor cells. All resection margins were negative. Further experience with more cases will be needed to establish the exact indication of endoscopic papillectomy for duodenal papillary NETs.

The therapeutic value of endoscopic papillectomy for adenoma in major duodenal papilla / 中华消化内镜杂志

Objective To study the therapeutic value of the endoscopic papillectomy for adenoma in the major duodenal papilla.Methods All 3 1 cases with the major duodenal papilla undergoing endoscopic papillectomy from January 2008 to June 2013 were retrospectively reviewed.The clinical data,endoscopic treatment,complications and follow-up were analysed.Results Endoscopic papillectomy was performed successfully in 29 patients.Post-operative pathology showed adenoma with low-grade dysplasia in 25 cases and high-grade dysplasia in 4 cases.One patient (3. 4%,1/29 )bled during operation;and there was no bleeding after operation. There was no perforation during and after the operation. Seventeen patients (58. 6%,17/29)developed hyperamylasemia and 3 patients(10. 3%,3/29)got mild pancreatitis,which were cured by conservative treatment.During follow-up,2 patients (6. 9%,2/29)with high-grade dysplasia had tumor recurrence after 6 months and 2 years respectively.The 27 other patients had no recurrence during the follow-up period.The shortest follow-up was 1 1 months,the longest was 5 years,with a mean time of 33. 5 ±8. 5 months.Conclusion Endoscopic papillectomy is feasible and safe for early tumors of the major duodenal papilla.Although the postoperative recurrence rate is low,it still needs close follow-up.

A Large Neuroendocrine Tumor of the Major Duodenal Papilla Removed by Endoscopic Papillectomy / 대한내과학회지

Neuroendocrine tumors (NET) of the major duodenal papilla are rare and the natural history of this disease is not clear. We experienced a case in a 31-year-old male. Duodenoscopy revealed an enlarged major duodenal papilla with central umbilication and nodularity. Endoscopic ultrasonography (EUS) demonstrated a 3-cm hypoechoic mass that was confined to the submucosa. A biopsy led to the diagnosis of a grade 1 NET. The patient refused surgery, so we performed an endoscopic papillectomy. The tumor was removed completely. The resected specimen confirmed the diagnosis of a well-differentiated NET and all resection margins were negative. Surgical resection is currently considered to be the gold standard for the treatment of a large NET of the major duodenal papilla; however, endoscopic resection is a possible treatment modality for patients at high surgical risk or who are reluctant to undergo surgery.

The efficacy of endoscopic papillectomy for tumors of major duodenal papilla / 中华消化内镜杂志

Objective To evaluate and analyse the efficacy and safety of endoscopic papillectomy for tumors of major duodenal papilla.Methods The clinical data of thirty-four patients with tumors of major duodenal papilla who were treated by endoscopic papillectomy were retrospectively reviewed,and the clinical outcome was summarized.Results The success rate of endoscopic papillectomy was 94.12％ (32/34),and the complete resection was 66.67％ (20/30).Short-term complications occurred in 10 cases,including postoperative gastrointestinal bleeding in 7cases and postoperative pancreatitis in 3 cases.Five cases need further surgical intervention for the reason that tumor was too deep in 2 cases,bile duct was invaded in 2 cases and conservational medication was unsuccessful in 1 case.Thirty-three cases were pathologically diagnosed as low grade intraepithelial neoplasia (LGIN),17 cases high grade intraepithelial neoplasia (HGIN),1 case carcinoid and 3 cases adenocarcinoma.The recurrence rate was 23.33 (7/33).tumor recurrence rate of HGIN was higher than that of LGIN(42.86％ VS10％,P =0.078).Conclusion Endoscopic papillectomy is an effective method for treating tumors of major duodenal papilla,however,hemorrhage is the main postoperative complication,the recurrence rate is higher in HGIN group.

A cadaveric study of distance between the terminations of the hepato- pancreatic and accessory pancreatic ducts in the duodenal mucosa.

Objective: The present paper is about the study of distance between minor and major duodenal papillae which was carried out on 30 cadaveric specimens of human duodeno-pancreas. With introduction of ERCP, the pattern of pancreatic ductal system visualization has attained popularity. Without the knowledge of the normal pattern of the duct system and its variations, a radiologist can’t interpret an Endoscopic Retrograde Cholangio-Pancreatography (ERCP) picture. So it becomes important to study the anatomy of pancreatic ducts, their relation to each other, to common bile duct and to duodenum in the available human cadavers. To visualise and to see distance between minor and major duodenal papillae is necessary for the endoscopist who aims to perform the dilation, stenting, or papillotomy of the minor papilla. ERCP is proved to be “first line” therapeutic tool in the management of surgical, medical and pathological disorders involving the biliary tree and pancreatic duct. Methods: The study was conducted in thirty (20 male and 10 female) cadavers. Major and minor duodenal papillae were visualized through eosin dye installation in both common bile duct and the accessory pancreatic duct. The measurement of distance between the duodenal papillae was done in cm. Results: In the present work, the distance measured between the major and minor duodenal papilla was on an average 1.93+0.61 cm. in females and in males it was 2.05+0.31 cm. Conclusion: The length of the duct shows sexual dimorphism; the length being more in males than females.

The anatomy of the pancreaticobiliary junction on magnetic resonance multi-planar imaging / 中华肝胆外科杂志

Objective To explore the use of magnetic resonance imaging (MRI) in the display of detailed anatomical structures at the pancreaticobiliary junction. Methods 112 patients who received enhanced MRI of upper abdomen were included in the study. Patients with pancreatic and/or biliary diseases diagnosed clinically and with laboratory tests were excluded. The types of junction between the terminal common bile duct and the pancreatic duct, and the location of the major duodenal papilla were studied on MRI. We measured the angle between the duodenum and the common pancreaticobiliary duct or the common bile duct. Results Of the 112 patients, the duodenal papillas were located at the upper, middle, and lower segment of the duodenum in 17. 0%, 66. 0% and 17. 0%, respectively.The angle between the common pancreaticobiliary duct or the distal common bile duct and the descending duodenum was 44. 4°±17. 3°. The pancreatic duct and the common bile duct opened separately in 9 patients (8. 0%). The confluence of the two ducts was present inside and outside of the duodenum wall in 13 (11. 6%) and 90 patients (80. 4%), respectively. The angle between the distal common bile duct and the pancreatic duct was 37. 8°±15.1°. Conclusion MRI was able to display detailed anatomical structures of the pancreaticobiliary junction, including the angle of the junction between the two ducts and the location of the duodenal papilla. It has the ability to provide meticulous anatomical data for the diagnosis and treatment of diseases at the pancreaticobiliary junction and to help surgeons formulate operative plans.

Treatment Outcome after Endoscopic Papillectomy of Tumors of the Major Duodenal Papilla / 대한소화기학회지

BACKGROUND/AIMS: Endoscopic papillectomy is reported to be relatively safe and reliable for complete resection of benign tumors of the major duodenal papilla. We evaluated methods and treatment outcome of the patients who have undergone endoscopic papillectomy. METHODS: Medical records of 22 consecutive patients with tumor of the major duodenal papilla (10 women, 12 men; mean age 55.8+/-2.8 yrs) who have undergone endoscopic papillectomy were reviewed retrospectively. Endoscopic papillectomy was defined the successful when complete excision of the tumor was achieved. RESULTS: Mean duration of follow-up was 8.4+/-2.4 months (range 1-43 months). Endoscopic papillectomy was successful in 16 patients (72.7%), but incomplete resection occurred in 6 patients. Only one patient showed recurrence. Histopathologic evaluation after endoscopic papillectomy revealed adenoma (n=11, 50%), high-grade dysplasia (n=3, 13.6%), adenocarcinoma (n=2, 9.1%), carcinoid (n=1), chronic inflammation (n=3, 13.6%), papillary adenomatous hyperplasia (n=1), and cavernous lymphangioma (n=1). The mean size of the resected lesions was 10.3+/-1.2 mm (range 2-20 mm). There was no factor which could predict the endoscopic success statistically. A pancreatic duct stent was placed in 11 patients (50.0%) and was removed after 3 to 39 days. There were 8 (36.8%) procedure-related complications: bleeding (n=4), papillary stenosis (n=1), perforation (n=1), cholangitis (n=1), and asymptomatic liver function abnormality (n=1). There was no pancreatitis or mortality. All the complications resolved with conservative management. CONCLUSIONS: Endoscopic papillectomy in selected patients seemed to be highly successful and safe. Longer follow-up is needed to assess the long-term efficacy.