Gut Liver.  2015 Sep;9(5):689-692. 10.5009/gnl14206.

Ampullary Adenoma Treated by Endoscopic Double-Snare Retracting Papillectomy

• Soma H
• Miyata N
• Hozawa S
• Higuchi H
• Yamagishi
• Nakamura Y
• Saeki K
• Kameyama K
• Masugi Y
• Yahagi N
• Kanai T

• KMID: 2234078
• DOI: http://doi.org/10.5009/gnl14206

Abstract

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.

Keyword

Argon plasma coagulation; Endoscopic papillectomy; Endosonography; Intraductal ultrasonography; Tubular adenoma

MeSH Terms

Adenoma/pathology/*surgery
Adult
Aged
Aged, 80 and over
Ampulla of Vater/pathology/*surgery
Biopsy
Common Bile Duct Neoplasms/pathology/*surgery
Dissection/*methods
Duodenoscopy/*methods
Feasibility Studies
Female
Humans
Male
Middle Aged
Neoplasm Recurrence, Local
Treatment Outcome