Endoscopic papillectomy： The limits of the indication,technique and results

• 作者: éder Rios Lima-Filho José Celso Ardengh José Sebasti?o dos Santos. Rafael Kemp
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: Epidemiology Ampullary TUMORS Endoscopicresection ENDOSCOPIC ultrasound STAGING ENDOSCOPIC PAPILLECTOMY Surgical AMPULLECTOMY
• 年，卷（期）: 2015,（10）
• 页码范围: 987-994
• 页数: 8页
• 分类号: R

摘要

In the majority of cases, duodenal papillary tumorsare adenomas or adenocarcinomas, but the endoscopybiopsy shows low accuracy to make the correct differentiation.Endoscopic ultrasonography and endoscopicretrograde cholangiopancreatography are importanttools for the diagnosis, staging and managementofampullary lesions. Although the endoscopic papillectomy（EP） represent higher risk endoscopic interventions, ithas successfully replaced surgical treatment for benignor malignant papillary tumors. The authors review theepidemiology and discuss the current evidence forthe use of endoscopic procedures for resection, theselection of the patient and the preventive maneuversthat can minimize the probability of persistent orrecurrent lesions and to avoid complications after theprocedure. The accurate staging of ampullary tumorsis important for selecting patients to EP or surgicaltreatment. Compared to surgery, EP is associatedwith lower morbidity and mortality, and seems to bea preferable modality of treatment for small benignampullary tumors with no intraductal extension. TheEP procedure, when performed by an experiencedendoscopist, leads to successful eradication in up to85% of patients with ampullary adenomas. EP is a safeand effective therapy and should be established as thefirst-line therapy for ampullary adenomas.