Background and study aims Papillary and duodenal carcinoma are aggressive cancers with poor 5-year survival rates. Papillectomy is a well-established treatment for early-stage carcinoma of the major papilla. Tumors arising in the minor papilla are relatively rare and there is little research available on the endoscopic management of these tumors. Patients and methods The purpose of this study was to establish the safety and efficacy of endoscopic papillectomy in the management of minor papillary tumors. A total of six patients undergoing ERCP for papillectomy for minor papillary tumor at four hospitals were included in this study over a period of 5 years. Results Papillectomy was technically successful in all six patients. Pathology revealed adenoma in three patients, adenoma with high-grade dysplasia in one patient, carcinoma in one patient, and carcinoid tumor in one patient. For follow-up, one patient had an additional tumor identified at 2 years which was found to be a recurrence of the original adenoma. This patient was treated with repeat papillectomy with no further evidence of recurrence. Conclusions In our pilot study, we demonstrate that endoscopic papillectomy appears safe and effective in the management of minor papillary tumors.

Appendicitis, an acute inflammation of the appendix, affects all demographic groups and exhibits various incidences and clinical manifestations. While acute appendicitis typically presents with colicky periumbilical abdominal pain that localizes to the right lower quadrant, atypical presentations are more common in children, geriatric, and pregnant patient populations, leading to delays in diagnosis. Clinical evaluation, clinical scoring systems, and inflammatory markers are commonly used, but their limitations have led to the increased use of diagnostic imaging in patients suspected of appendicitis. Acute appendicitis is managed by non-operative and operative management, depending on whether it is uncomplicated or complicated. Developing diagnostic pathways to improve outcomes and reduce complications is crucial. Although medical advancements have been made, diagnosing and managing appendicitis can be challenging, mainly when patients are present atypically. This literature review aims to comprehensively review typical and atypical presentations of appendicitis and their current implications for diagnosis and treatment modalities in pediatric, adult, pregnant, and geriatric patient populations.

BackgroundStents utilized for pyloric, duodenal, or anastomotic malignant strictures are generally uncovered and are not retrievable. Taewoong Medical created a through-the-scope stent that is fully covered, retrievable, and can be placed beyond the esophagus for benign gastroduodenal strictures as an alternative to surgical approaches. The aim of this paper is to examine the safety and efficacy of short-term, fully covered, selfexpanding metal stents (FC-SEMS) in refractory benign strictures of the pylorus, duodenum, and gastrojejunal anastomosis. MethodologyThis multicenter case series was conducted at four hospitals from January 2018 through December 2020. Patients presenting with benign strictures of the pylorus, duodenum, or gastrojejunal anastomosis were entered into the study. A therapeutic channel scope was utilized to place FC-SEMS to open strictures. The stents were removed a few weeks later. A four-point gastric outlet obstruction scoring system (GOOSS) was used to record improvement. ResultsStatistically significant improvement in GOOSS was found between the pre-procedure and the four-week follow-up. ConclusionsFully covered, retrievable metal stents appear safe and effective in the management of refractory benign pyloric, duodenal, and anastomotic strictures. This may provide a less invasive option in the management of these strictures compared to surgery.

INTRODUCTION: Ampullary and duodenal carcinoma are aggressive cancers with poor 5 year survival rates. Like colorectal cancer, ampullary and duodenal carcinomas are also thought to follow the adenoma-carcinoma sequence. Ampullectomy is a well-established treatment for early stage carcinoma of major ampulla. Several studies have established its safety and efficacy in the management of major ampullary tumor. However, tumors arising in the minor ampulla are relatively rare and there are no good case series on endoscopic management of these tumors. We report a multicenter case series of endoscopic ampullectomy in the management of minor ampullary tumors. METHODS: To establish the safety and efficacy of endoscopic ampullectomy in the management of minor ampullary tumors. Consecutive patients undergoing ampullectomy for minor ampullary tumor at four hospitals were included in this study over a period of 5 years. A total of 6 patients were included in the study and all six patients underwent ERCP for purpose of minor ampullectomy. MRCP and EUS was performed on all patients prior to ERCP to rule out invasion. Pancreatic stents were placed after ampullectomy in 5 patients. RESULTS: Ampullectomy was technically successful in all 6 patients. One patient required two ERCPs for complete ampullectomy. The tumors varied in size from 1 cm to 3 cm. Pathology revealed adenoma in three patients, adenoma with high grade dysplasia in one patient, carcinoma in one patient, and carcinoid tumor in one patient. One patient (16%) developed post ERCP pancreatitis; this patient was kept in the hospital for 2 days. No other major complications were noted. Follow-up for these patients ranged from 2 to 5 years with EGD using duodenoscope at 3 months, one year and yearly thereafter. One patient had recurrence at 2 years which was thought to be recurrent tumor (4 mm). This patient was treated with repeat ampullectomy. CONCLUSION: This study demonstrates the safety and efficacy of endoscopic removal of minor ampullary tumors. Our case-series showed a comparable rate of procedure-related complication of (16.6%), as one out of six patients was found to have pancreatitis. The other 5 patients had no complications and were discharged within 24 hours. Among the patients who followed up, there were no recurrences of tumor and no patient was found to have cancer develop over a mean follow-up period of 2 to 5 years. This demonstrates that complete removal of these lesions via endoscopic resection is safe and has favorable outcomes.

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