Endoscopic management of tumors of minor ampulla: a multicenter study

Abstract

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.

Endoscopic papillectomy for synchronous adenoma of the major and minor duodenal papilla

“…9 Though endoscopic resection of the minor papilla neoplasia is seldom reported, case reports and small case series have suggested that EP is also an alternative treatment for minor papillary tumors. 10,18 The most common indication for EP is benign adenoma of the pancreatic duct or bile duct with no intraductal involvement. 19 Surgical resection is required for malignant lesions.…”

“…However, in recent years, studies have revealed that EP is a safe and minimally invasive alternative to pancreatoduodenectomy for the treatment of ampullary adenoma 9 . Though endoscopic resection of the minor papilla neoplasia is seldom reported, case reports and small case series have suggested that EP is also an alternative treatment for minor papillary tumors 10,18 …”

“…Some studies suggest that EMR is a treatment option for noninvasive tumors of the minor papilla, 32,33 whereas others consider snare papillectomy as a safe and effective method. 10,34 In this study we assume that snare excision is a safe method for minor duodenal papilla adenomas.…”

“…Unlike those of the major papilla, tumors of the minor papilla are uncommon and have only been described in case reports and small case series. Almost all cases of the minor papilla tumors are adenomas, neuroendocrine tumors such as carcinoids, and somatostatinomas 10 . Moreover, few cases of synchronous major and minor papilla neoplasms have been reported 11–13 .…”

“…Almost all cases of the minor papilla tumors are adenomas, neuroendocrine tumors such as carcinoids, and somatostatinomas. 10 Moreover, few cases of synchronous major and minor papilla neoplasms have been reported. [11][12][13] In this study we reported nine cases of synchronous major and minor papilla adenomas that were treated by EP aiming to evaluate its safety and efficacy.…”