Endoscopic management of tumors of the major duodenal papilla: Refined techniques to improve outcome and avoid complications

Desilets, David J.; Dy, Robert M.; Ku, Phyllidia M.; Hanson, Brian L.; Elton, Eric; Mattia, Anthony R.; Howell, Douglas A.

doi:10.1067/mge.2001.116564

Cited by 200 publications

(184 citation statements)

References 18 publications

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“…The aim with a biliar or pancreatic sphincterotomy and placement of a stent is to enhance the technical success and decrease the complications of endoscopic ampullectomy (4,13,48,(57)(58)(59). However, a preresection sphincterotomy has some drawbacks.…”

Section: Sphincterotomy and Stent Placementmentioning

confidence: 99%

“…However, the benefits of this adjunctive therapy remain controversial, with overall success rate, in a large series, similar in patients who had adjuvant thermal ablation (81%) compared with those who did not (78%) (9). Ablation can be performed with monopolar coagulation (31,48), bipolar coagulation (48), Nd: YAG laser (11,48,56), photodynamic therapy (11), and argon plasma coagulation (APC) (13,48). We prefer to use APC (setting of 40 to 50 watts) to ablate residual tissue.…”

Section: Thermal Tissue Ablationmentioning

confidence: 99%

“…More recently, many other series have reported low morbidity and mortality with endoscopic therapy (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). However, the role of endoscopic ampullectomy remains controversial and it is generally performed only in reference centers with expertise in interventional endoscopy.…”

Section: Endoscopic Ampullectomymentioning

confidence: 99%

“…Epinephrine and methylene blue may help minimize bleeding and enhance endoscopic visualization of the lesions margins, respectively. Local saline injection may increase technical success and decrease complications similar to mucosectomy (13,48). However, this technique is not recommended by other authors because submucosal saline injection may involve certain disadvantages: a) the center of the ampullary lesion is tethered down by the biliary and pancreatic ducts, and it may not lift; b) injection may create a dome effect and make effective snare placement for en bloc resection more difficult (13,(48)(49)(50); and c) there are reports of increased risk of postresection pancreatitis.…”

Section: Submucosal Injectionmentioning

confidence: 99%

“…Endoscopic ampullectomy may be considered in patients with smaller lesions that do not contain invasive carcinoma, and in patients who are poor surgical candidates (4)(5)(6). Many series have reported low morbidity and mortality with endoscopic therapy (4,(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). Limited data support particular techniques for endoscopic resection of ampullary tumors (e.g.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic ampullectomy: A technical review

Espinel¹,

Pinedo²,

Ojeda³

et al. 2015

Rev Esp Enferm Dig

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Background and aim:This article provides a practical review to undertaking safe endoscopic ampullectomy and highlights some of the common difficulties with this technique as well as offering strategies to deal with these challenges.Methods: We conducted a review of studies regarding endoscopic ampullectomy for ampullary neoplasms with special focus on techniques.Results: Accurate preoperative diagnosis and staging of ampullary tumors is imperative for predicting prognosis and determining the most appropriate therapeutic approach. The optimal technique for endoscopic ampullectomy is dependent on the lesions size. En bloc resection is recommended for lesions confined to the papilla. There is no significant evidence to support the submucosal injection before ampullectomy. There is no consensus regarding the optimal current and power output for endoscopic ampulectomy. The benefits of a thermal adjunctive therapy remain controversial. A prophylactic pancreatic stent reduces the incidence and severity of pancreatitis post-ampullectomy.Conclusions: Endoscopic ampullectomy is a safe and efficacious therapeutic procedure for papillary adenomas in experienced endoscopist and it can avoid the need for surgical intervention.

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