scholarly journals Endoscopic Diagnosis of Ampullary Tumors Using Conventional Endoscopic Ultrasonography and Intraductal Ultrasonography in the Era of Endoscopic Papillectomy: Advantages and Limitations

2014 ◽  
Vol 47 (2) ◽  
pp. 127 ◽  
Author(s):  
Jong Ho Moon
Keyword(s):  
Endoscopic Ultrasonography ◽  
Endoscopic Diagnosis ◽  
Intraductal Ultrasonography ◽  
Endoscopic Papillectomy ◽  
Ampullary Tumors

scholarly journals Endoscopic management of ampullary tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Endoscopy ◽  
2021 ◽  
Author(s):  
Geoffroy Vanbiervliet ◽  
Marin Strijker ◽  
Marianna Arvanitakis ◽  
Arthur Aelvoet ◽  
Urban Arnelo ◽  
...  
Keyword(s):  
Clinical Success ◽  
Endoscopic Management ◽  
R0 Resection ◽  
En Bloc ◽  
Strong Recommendation ◽  
Moderate Quality ◽  
Endoscopic Papillectomy ◽  
Pancreatic Duct Stenting ◽  
Ampullary Tumors ◽  
Quality Evidence

Main Recommendations 1 ESGE recommends against diagnostic/therapeutic papillectomy when adenoma is not proven.Strong recommendation, low quality evidence. 2 ESGE recommends endoscopic ultrasound and abdominal magnetic resonance cholangiopancreatography (MRCP) for staging of ampullary tumors.Strong recommendation, low quality evidence. 3 ESGE recommends endoscopic papillectomy in patients with ampullary adenoma without intraductal extension, because of good results regarding outcome (technical and clinical success, morbidity, and recurrence).Strong recommendation, moderate quality evidence. 4 ESGE recommends en bloc resection of ampullary adenomas up to 20–30 mm in diameter to achieve R0 resection, for optimizing the complete resection rate, providing optimal histopathology, and reduction of the recurrence rate after endoscopic papillectomy.Strong recommendation, low quality evidence. 5 ESGE suggests considering surgical treatment of ampullary adenomas when endoscopic resection is not feasible for technical reasons (e. g. diverticulum, size > 4 cm), and in the case of intraductal involvement (of > 20 mm). Surveillance thereafter is still mandatory.Weak recommendation, low quality evidence. 6 ESGE recommends direct snare resection without submucosal injection for endoscopic papillectomy.Strong recommendation, moderate quality evidence. 7 ESGE recommends prophylactic pancreatic duct stenting to reduce the risk of pancreatitis after endoscopic papillectomy.Strong recommendation, moderate quality evidence. 8 ESGE recommends long-term monitoring of patients after endoscopic papillectomy or surgical ampullectomy, based on duodenoscopy with biopsies of the scar and of any abnormal area, within the first 3 months, at 6 and 12 months, and thereafter yearly for at least 5 years.Strong recommendation, low quality evidence.

scholarly journals Endosonographic Preoperative Evaluation for Tumors of the Ampulla of Vater Using Endoscopic Ultrasonography and Intraductal Ultrasonography

2014 ◽  
Vol 47 (2) ◽  
pp. 174 ◽  
Author(s):  
Naoki Okano ◽  
Yoshinori Igarashi ◽  
Seiichi Hara ◽  
Kensuke Takuma ◽  
Itaru Kamata ◽  
...  
Keyword(s):  
Endoscopic Ultrasonography ◽  
Preoperative Evaluation ◽  
Ampulla Of Vater ◽  
Intraductal Ultrasonography

scholarly journals A Novel Technique of Endoscopic Papillectomy with Hybrid Endoscopic Submucosal Dissection for Ampullary Tumors: A Proof-of-Concept Study (with Video)

2020 ◽  
Vol 9 (8) ◽  
pp. 2671
Author(s):  
Naminatsu Takahara ◽  
Yosuke Tsuji ◽  
Yousuke Nakai ◽  
Yukari Suzuki ◽  
Akiyuki Inokuma ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Demographic Data ◽  
Postoperative Bleeding ◽  
Incomplete Resection ◽  
Proof Of Concept ◽  
Procedure Time ◽  
Concept Study ◽  
Submucosal Dissection ◽  
Endoscopic Papillectomy ◽  
Ampullary Tumors

Background: Endoscopic papillectomy (EP) carries a potential risk of procedure-related adverse events and incomplete resection. Since hybrid endoscopic submucosal dissection (ESD) had been established as an alternative option for relatively large and difficult gastrointestinal tumors, we evaluated a novel EP with hybrid ESD (hybrid ESD-EP) for curative safe margin in this proof-of-concept study. Methods: A total of eight cases who underwent hybrid ESD-EP between 2018 and 2020 were identified from our prospectively maintained database. Hybrid ESD-EP involved a (sub)circumferential incision with partial submucosal dissection, and subsequent snare resection of ampullary tumors, which was performed by two endoscopists with expertise in ESD or endoscopic retrograde cholangiopancreatography. Demographic data and clinicopathological outcomes were retrospectively evaluated. Results: En bloc resection was achieved by hybrid ESD-EP in all eight cases, with the median procedure time of 112 (range: 65–170) minutes. The median diameters of the resected specimens and tumors were 18 and 12 mm, respectively. All lateral margins were clear, whereas vertical margin was uncertain in three (38%), resulting in the complete resection rate of 63%. Postoperative bleeding and pancreatitis developed in each one (13%). No tumor recurrence was observed even in those cases with uncertain vertical margin, after a median follow-up of 244 (range, 97–678) days. Conclusions: Hybrid ESD-EP seems to be feasible and promising in ensuring the lateral resection margin. However, further investigations, especially to secure the vertical margin and to shorten the procedure time, should be required.

scholarly journals The Diagnosis of Autoimmune Pancreatitis Using Endoscopic Ultrasonography

Diagnostics ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. 1005
Author(s):  
Atsushi Kanno ◽  
Eriko Ikeda ◽  
Kozue Ando ◽  
Hiroki Nagai ◽  
Tetsuro Miwata ◽  
...  
Keyword(s):  
Bile Duct ◽  
Pancreatic Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Endoscopic Ultrasonography ◽  
Autoimmune Pancreatitis ◽  
Wall Thickening ◽  
Endoscopic Retrograde ◽  
Intraductal Ultrasonography ◽  
Bile Duct Wall ◽  
Duct Wall

Autoimmune pancreatitis (AIP) is characterized by enlargement of the pancreas and irregular narrowing of the main pancreatic duct. It is often associated with IgG4-related sclerosing cholangitis (IgG4-SC), in which the bile duct narrows. Although characteristic irregular narrowing of the pancreatic duct caused by endoscopic retrograde cholangiopancreatography is noted in AIP, it is difficult to differentiate between localized AIP and pancreatic carcinoma based on imaging of the pancreatic duct. While stenosis of the bile duct in IgG4-SC is characterized by longer-length stenosis than in cholangiocarcinoma, differentiation based on bile duct imaging alone is challenging. Endoscopic ultrasound (EUS) can characterize hypoechoic enlargement of the pancreas or bile duct wall thickening in AIP and IgG4-SC, and diagnosis using elastography and contrast-enhanced EUS are being evaluated. The utility of EUS-guided fine needle aspiration for the histological diagnosis of AIP has been reported and is expected to improve diagnostic performance for AIP. Findings in the bile duct wall from endoscopic retrograde cholangiopancreatography followed by intraductal ultrasonography are useful in differentiating IgG4-SC from cholangiocarcinoma. Diagnoses based on endoscopic ultrasonography play a central role in the diagnosis of AIP.

Tu1532 Comparative Study Between the Pre-Procedural Biopsy and the Final Diagnosis of Endoscopic Papillectomy: Does Pre-Biopsy Always Reflect the Ampullary Tumors?

2016 ◽  
Vol 83 (5) ◽  
pp. AB598
Author(s):  
Kenjiro Yamamoto ◽  
Takao Itoi ◽  
Atsushi Sofuni ◽  
Takayoshi Tsuchiya ◽  
Shujiro Tsuji ◽  
...  
Keyword(s):  
Comparative Study ◽  
Final Diagnosis ◽  
Endoscopic Papillectomy ◽  
Ampullary Tumors

4625 Endoscopic ultrasound and intraductal ultrasonography are complementary for the management of ampullary tumors.

2000 ◽  
Vol 51 (4) ◽  
pp. AB186
Author(s):  
Bertrand Napoleon ◽  
Jean Christophe Saurin ◽  
Rosario Albis ◽  
Jean Yves Scoazec ◽  
Thierry Ponchon ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Intraductal Ultrasonography ◽  
Ampullary Tumors

scholarly journals Successful Endoscopic Resection of Tubulovillous Adenoma Arising in Choledochocele

2021 ◽  
Vol 26 (1) ◽  
pp. 58-62
Author(s):  
Shin Hee Lee ◽  
Kyu-hyun Paik ◽  
Han Beol Jang ◽  
Jun Hyung Park ◽  
Jong Ok Kim ◽  
...  
Keyword(s):  
Malignant Transformation ◽  
Endoscopic Resection ◽  
Endoscopic Ultrasonography ◽  
Ampullary Carcinoma ◽  
Common Type ◽  
High Grade ◽  
Tubulovillous Adenoma ◽  
En Bloc ◽  
Endoscopic Papillectomy ◽  
Ampullary Tumor

Choledochocele is the least common type of choledochal cyst. Choledochocele has a potential for carcinogenesis, but only a handful of cases with concurrent ampullary carcinoma have been reported. We recently experienced a case of choledochocele with tubulovillous adenoma with focal high-grade dysplasia, which was successfully and completely resected en bloc via endoscopic papillectomy. Prior to endoscopic papillectomy, the endoscopic ultrasonography was able to accurately diagnose the ampullary tumor arising in choledochocele. Herein, we would like to report this case and discuss the potential of malignant transformation and the usefulness of endoscopic ultrasonography in choledochocele.

scholarly journals Endoscopic papillectomy for tumors of the major duodenal papilla

2019 ◽  
Vol 24 (1) ◽  
pp. 36-42 ◽  
Author(s):  
I. Yu. Nedoluzhko ◽  
E. I. Khon ◽  
K. V. Shishin
Keyword(s):  
Postoperative Bleeding ◽  
Length Of Hospital Stay ◽  
En Bloc Resection ◽  
Prolonged Treatment ◽  
Morbidity Rate ◽  
Invasive Treatment ◽  
En Bloc ◽  
Endoscopic Papillectomy ◽  
Pancreatic Duct Stenting ◽  
Ampullary Tumors

Aim.To evaluate an effectiveness of endoscopic papillectomy (EA) for benign ampullary tumors.Material and methods.There were 45 patients with ampullary tumors who underwent endoscopic papillectomy in 2014–2018. Mean dimension of tumor was 2.25 ± 1.75 cm.Results.Papillectomy was successfully performed in all cases. En-bloc resection was completed in 24 cases (53%), while 21 (47%) patients had a piecemeal resection. Pancreatic duct stenting was carried out in 30 (67%) cases. Postoperative complication rate was 31%. Postoperative bleeding occurred in 8 (18%) cases, perforation in 4 (8.9%) cases, acute pancreatitis in 2 (4.4%) cases. Mortality was 4.4 % (n= 2). Local recurrence rate within 4-year period was 2.2% (n= 1). Mean length of hospital-stay was 13 days (13 ± 11) considering prolonged treatment of patients with complicated postoperative period.Conclusion.Endoscopic papillectomy is effective minimally invasive treatment of benign ampullary tumors. Regardless considerable morbidity rate, all of them may be effectively managed by medication or endoscopic procedure. EP can be considered as a first-line treatment of benign ampullary tumors.

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