Endoscopic pancreaticobiliary drainage with overlength stents to prevent delayed perforation after endoscopic papillectomy: A pilot study

Radiation-free endoscopic papillectomy for ampullary adenoma: experience from a Chinese tertiary hospital

BACKGROUND

Conventional endoscopic papillectomy (ESP) for ampullary adenoma is performed as a hybrid endoscopy and fluoroscopy guided procedure. In this study, we report our preliminary experience of non-radiation ESP.

METHODS

The present method includes endoscopic snare resection, non-radiation endoscopic biliary and pancreatic stenting and endoclipping. Data from ten patients who underwent non-radiation ESP due to ampullary adenoma were collected. Procedure details, adverse events and follow-up were analyzed.

RESULTS

Complete resection was accomplished in all patients, with en bloc resection and piecemeal resection in nine and one patient(s), respectively. Both biliary and pancreatic stenting and biliary stenting alone were achieved in eight and two patients, respectively. Endoclipping was performed in all patients. Hyperleukocytosis and hyperamylasemia occurred in two and one patient(s), respectively. No other complications occurred. No lesion residual or recurrence occurred during follow-up.

CONCLUSIONS

Radiation-free ESP can be technically feasible and safely executed by experienced endoscopists. Our study provides a novel strategy for endoscopic resection of major papilla adenoma.

Multi-slice spiral CT findings of tubulovillous adenoma of the duodenum

OBJECTIVES

To analyze the appearance of duodenal tubulovillous adenoma on multi-slice spiral CT images to facilitate early diagnosis and treatment to potentially improve prognosis.

METHODS

We retrospectively analyzed clinical data and CT imaging findings of 11 cases of duodenal tubulovillous adenomas, all confirmed by pathology. The location, size, shape, CT density, relationship with surrounding structures, accompanying bile duct obstruction, and enhancement pattern of each lesion were documented.

RESULTS

All 11 lesions occurred in the descending part of the duodenum. Ten cases occurred in the duodenal papilla area. Nine cases had a low-density ring sign or semicircle sign between the lesion and the adjacent normal intestinal wall on axial images. Eight cases had differing degrees of bile duct dilatation, five of which had concomitant pancreatic duct dilatation. Noncontrast images revealed uniform soft tissue density; contrast enhanced images showed moderate, mostly uniform enhancement, with the most enhancement in the venous phase. In the arterial phase, two lesions showed linear enhancing vessels.

CONCLUSIONS

On multi-slice spiral CT imaging, duodenal tubulovillous adenomas have certain characteristics that could be used for clinical diagnosis and treatment.

PRECIS

On multi-slice spiral CT imaging of duodenal tubulovillous adenoma, findings of nodular or cauliflower-like shape, uniform density, uniform moderate enhancement, and a peripheral low-density ring sign could improve diagnostic accuracy.

Endoscopic papillectomy for ampullary adenomatous lesions: A literature review

Ampullary adenomatous lesions of the gastrointestinal tract are rare and can be asymptomatic. Therefore, ampullary adenomas with malignant potential require prompt removal, regardless of whether they are adenomatous or carcinomatous lesions. Endoscopic papillectomy is a safe and effective alternative therapy to surgery to treat duodenal papillary lesions in selected patients. Accurate preoperative diagnosis and staging of ampullary adenomatous lesions are critical for predicting prognosis and determining the most appropriate therapeutic approach. Furthermore, the management and prevention of adverse events and endoscopic treatment for remnant or recurrent lesions and surveillance are essential for successful endoscopic management of ampullary adenomatous lesions. This literature review was based on PubMed and MEDLINE and focused on recent advancements in the endoscopic papillectomy technique to provide a comprehensive view of endoscopic papillectomy to treat ampullary adenomatous lesions.