The Usefulness of Endoscopic Resection of the Adenoma of the Papilla of Vater.

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  • 十二指腸乳頭部腺腫に対する内視鏡的乳頭切除術の有用性

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Abstract

We investigated the usefulness of the endoscopic resection of the tumor of the papilla. Thirty patients have been diagnosed to have the tumor of the papilla on endoscopic examination with a side-viewing videoendoscopy. The endoscopic findings were classified as three types (I: tumor type, II: granular type, III: normal-like type). All the 30 adenomas of the papilla diagnosed as adenoma by the biopsy under direct vision on endoscopy and limited to the mucosal layer by imaging modalities. Excision was performed in a radical fashion using pure cutting current. The resected specimen was submitted to histologic analysis by serial sectioning. We compared biopsy specimens with the resected tumor to compare to the pathological diagnosis. We examined the pathological diagnosis and the complications of this endoscopic procedure. The final pathological diagnosis by the resected specimens were cancer in 2 of 30 cases and adenomain the remaining cases. As for the tumor in the margin of the resected specimens, tumor is free in 15 of 30 cases (50%). After treatment, the pathological diagnosis of the biopsy from the edge of the ulcer after the resection is free of the residual tumor in 10 of 15 cases (67%) and positive in the remaining 5 cases (33%). In the 5 cases, we treated the residual tumor by hot biopsy. On the resection of the tumor, perforation of the duodenal wall was not seen. Duodenal bleeding was seen in one case after the resection. A cute pancreatitis was seen in 1 out of 30 cases (3%). Serum Hemoglobin fell beyond 3g/dl in 7 cases. Obstructive jaundice beyond 3mg/dl in total bilirubin was seen in 3 among 30 cases (10%). These complications recovered by conservative therapy. In conclusion the endoscopic resection of the adenoma of the papilla of Vater was a safe treatment and useful in the final pathological diagnosis of the adenoma diagnosed by biopsy.

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