Ampullary Adenoma Treated by Endoscopic Double-Snare Retracting Papillectomy

• Published in: Gut and liver Vol. 9; no. 5; pp. 689 - 692
• Main Authors: Soma, Hiromitsu, Miyata, Naoteru, Hozawa, Shigenari, Higuchi, Hajime, Yamagishi, Yoshiyuki, Nakamura, Yuji, Saeki, Keita, Kameyama, Kaori, Masugi, Yohei, Yahagi, Naohisa, Kanai, Takanori
• Format: Journal Article
• Language: English
• Published: Korea (South) Gut and Liver 01.09.2015; Gastroenterology Council for Gut and Liver; 거트앤리버 소화기연관학회협의회
• Subjects: Adenoma - pathology; Adenoma - surgery; Adult; Aged; Aged, 80 and over; Ampulla of Vater - pathology; Ampulla of Vater - surgery; argon plasma coagulation; Biopsy; Brief Communication; Common Bile Duct Neoplasms - pathology; Common Bile Duct Neoplasms - surgery; Dissection - methods; Duodenoscopy - methods; endoscopic papillectomy; endosonography; Feasibility Studies; Female; Humans; intraductal ultrasonography; Male; Middle Aged; Neoplasm Recurrence, Local; Treatment Outcome; tubular adenoma; 내과학; Endosonography; Intraductal ultrasonography; Argon plasma coagulation; Endoscopic papillectomy; Tubular adenoma
• ISSN: 1976-2283; 2005-1212
• DOI: 10.5009/gnl14206

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.