Endoscopic Papillectomy for Tumors of the Duodenal Major Papilla

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.