Endoscopic papillectomy into the treatment of neoplastic lesions of vater papilla.

ABSTRACT

UNLABELLED 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 (FM, 57, 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.