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首页> 外文期刊>Surgical Endoscopy >Endoscopic snare papillectomy with biliary and pancreatic stent placement for tumors of the major duodenal papilla.
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Endoscopic snare papillectomy with biliary and pancreatic stent placement for tumors of the major duodenal papilla.

机译：内镜下圈套式胆囊切除术和胆胰支架置入术治疗主要十二指肠乳头肿瘤。

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BACKGROUND: This study aimed to evaluate the feasibility, safety, and follow-up results of endoscopic papilletomy (ESP) with pancreatic and biliary duct stent placement for ampullary tumors. The therapeutic approach to benign ampullary tumors remains unsettled. The ESP procedure is a curative treatment option for benign papillary tumors, but ESP raises concerns about a relatively high risk for procedure-related complications such as pancreatitis. A pancreatic stent may protect against complications. METHODS: Between September 2000 and June 2008, 36 patients with ampullary tumors confined to the mucosa and no intraductal tumor growth underwent ESP. The preprocedural diagnostic tools included endoscopic ultrasound, transpapillary intraductal ultrasound, and endoscopic retrograde cholangiopancreatography. Pancreatic and biliary stent placement was attempted if feasible. Endoscopic follow-up evaluation was conducted periodically as surveillance for recurrence. RESULTS: En bloc ESP was achieved for 94% of lesions with a median size of 14 mm. There were 26 adenomas including 4 high-grade intraepithelial neoplasias (HGINs), 5 carcinomas in adenoma, and 3 intramucosal cancers. Complete resections with tumor-free lateral and basal margins was achieved for 81% of the cases. During the median follow-up period of 14 months, there was one recurrent adenoma, which was successfully eradicated by a repeat ESP. A pancreatic stent was placed in 35 cases and a biliary stent in 29 cases. Mild acute pancreatitis and bleeding, managed endoscopically, occurred in 3 cases each (8%). CONCLUSION: The ESP procedure can be feasible for benign ampullary adenoma, HGIN, and noninvasive cancer without intraductal tumor growth. Prophylactic stent placement in the pancreatic and bile ducts may reduce procedure-related complications.
机译：背景：本研究旨在评估胰管和胆道支架置入术对壶腹肿瘤的可行性，安全性和随访结果。良性壶腹肿瘤的治疗方法仍未解决。 ESP手术是良性乳头状肿瘤的治疗选择，但是ESP引起了与手术相关的并发症（例如胰腺炎）的相对较高风险的担忧。胰支架可以预防并发症。方法：2000年9月至2008年6月，对36例壶腹肿瘤局限于粘膜且无导管内肿瘤生长的患者进行了ESP。术前诊断工具包括内镜超声，经乳头导管内超声和内镜逆行胰胆管造影。如果可行，尝试放置胰胆管支架。定期进行内镜随访评估，以监测复发情况。结果：94％的病灶获得了整体ESP，中位大小为14 mm。有26个腺瘤，包括4个高度上皮内瘤样变（HGIN），5个腺瘤癌和3个粘膜内癌。 81％的病例完全切除了无肿瘤的外侧和基底边缘。在中位随访期14个月中，有1例复发性腺瘤，通过重复进行ESP手术已成功根除。胰支架置入35例，胆道支架置入29例。内镜处理的轻度急性胰腺炎和出血各发生3例（8％）。结论：ESP程序对于良性壶腹腺瘤，HGIN和无导管内肿瘤生长的非浸润性癌是可行的。将预防性支架置入胰管和胆管可减少与手术相关的并发症。

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