Korean Journal of Gastrointestinal Endoscopy 2006;32(2): 87-93.
십이지장 주유두 종양의 내시경 유두절제술
김명환·문창모·방승민·박병규·박승우·송시영·정재복
연세대학교 의과대학 내과학교실, 소화기병연구소
Endoscopic Papillectomy for Tumors of the Duodenal Major Papilla
Myoung Hwan Kim, M.D., Chang Mo Moon, M.D., Seungmin Bang, M.D., Byung Kyu Park, M.D., Seung Woo Park, M.D., Si Young Song, M.D. and Jae Bock Chung, M.D.
Department of Internal Medicine, Yonsei University College of Medicine, Institute of Gastroenterology, Seoul, Korea
Abstract
Background/Aims: A surgical resection has traditionally been used to treat tumors of the duodenal major papilla. However, radical surgery may cause significant morbidity and mortality. Endoscopic papillectomy has been reported in patients with benign papillary tumors. We evaluated the safety and outcomes of endoscopic papillectomy in patients with a papillary tumor. Methods: Between January 1994 and December 2003, fifteen patients with ampullary tumors underwent an endoscopic papillectomy using a snare resection. Endoscopic papillectomy was performed in 13 patients diagnosed with an adenoma and in 2 patients diagnosed with an adenocarcinoma, who were contraindicated for surgery. Results: Endoscopic papillectomy was performed in fifteen patients (11 men, 4 women: median age 61.7 years). All the tumors were removed either "en bloc" (14 tumors) or in a "piecemeal" fashion (one tumor). Ten patients were available for follow-up (median, 20.9 months: range, 1∼62 months). The procedure-related complications were bleeding (n=1), pancreatitis (n=3), and a duodenal perforation (n=1). The follow-up endoscopy revealed a recurrent adenocarcinoma in 2 patients after 13 months (20%). Conclusions: Endoscopic papillectomy is a useful alternative for treating a papillary adenoma. The relatively high incidence of pancreatitis this study suggests that stenting into the pancreatic duct will be needed to prevent postprocedure pancreatitis. (Korean J Gastrointest Endosc 2006;32:8793)
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