| Theme |
Advances in Diagnosis and Endoscopic Treatment for Pancreatic and Biliary Lesion |
| Title |
Endoscopic Therapy for Tumors of Major Duodenal Papilla |
| Author |
Akihiro Itoh |
Department of Gastroenterology, Nagoya University Graduate School of Medicine |
| Author |
Yoshiki Hirooka |
Department of Endscopy, Nagoya University Hospital |
| Author |
Hiroki Kawashima |
Department of Gastroenterology, Nagoya University Graduate School of Medicine |
| Author |
Naoki Ohmiya |
Department of Gastroenterology, Nagoya University Graduate School of Medicine |
| Author |
Yasumasa Niwa |
Department of Gastroenterology, Nagoya University Graduate School of Medicine |
| Author |
Hidemi Goto |
Department of Gastroenterology, Nagoya University Graduate School of Medicine |
| [ Summary ] |
Endoscopic ultrasonography and intraductal ultrasonography (IDUS) are useful for diagnosing tumor extension into the major duodenal papilla. IDUS makes it possible to diagnose early cancer that has not been correctly diagnosed through other modalities. On the other hand, it is thought that endoscopic resection therapy of tumors, which are considered to be benign adenomas or early cancer, may be initially selected as candidates for curative treatments such as endoscopic mucosal resection used for early gastric or colonic cancer. Between 1993 and 2006, 77 patients with tumors of the major duodenal papilla underwent endoscopic papillectomy in our institute. Histopathological diagnoses of 53 benign adenomas and 24 cancers were produced. Indications for this therapy were defined as cases with adenoma or early cancer without intraductal (bile duct or pancreatic duct) infiltration. The tumors were resected in a radical fashion using a diathermy snare. Temporary endoscopic pancreatic duct stenting may prevent acute post papillectomy pancreatitis, which is a significant early complication. There were a limited number of cases with late complications, but all cases improved to some degree. Endoscopic papillectomy can be assessed as a safe and curative treatment for adenoma or early cancer of the major duodenal papilla. |