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Coeuriot C, Pontarrasse J, Bouhsina N, Lazard M, Bertrand A, Fusellier M. Ultrasound appearance of the duodenal papilla in clinically healthy cats. J Feline Med Surg 2022; 24:1267-1273. [PMID: 35254144 DOI: 10.1177/1098612x221078783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The duodenal papilla (DP) is an anatomical structure located in the duodenal wall, a few centimetres from the pylorus. In cats, the pancreatic and bile ducts merge as they enter the DP, and this explains why cats are more likely than dogs to have concomitant digestive, pancreatic and hepatic infections. Ultrasonography of the DP has been previously established in dogs but not in cats. The purpose of our prospective study was to describe the ultrasound features of the DP in 30 adult clinically healthy cats. METHODS A full abdominal ultrasound was performed. Five measurements were recorded: the width and the height in a transverse section; the length and the height in a longitudinal section; and the thickness of the duodenal wall adoral to the DP in a longitudinal section. The subjective appearance (echogenicity and shape) of the DP was described. RESULTS The dimensions of the DP were a mean ± SD width of 3.13 ± 0.68 mm and height of 2.47 ± 0.63 mm in the transverse section, and length of 3.98 ± 1.27 mm and height of 2.44 ± 0.57 mm in the longitudinal section. The DP was homogeneous, subjectively isoechoic to fat and had a round and oval shape in the transverse and longitudinal sections, respectively. There was no correlation between the DP measurements and the weight, age or sex of the cats. The animals that were fed a mixed diet had a longer DP than those fed dry food. CONCLUSIONS AND RELEVANCE This study provides reference values for the dimensions of the DP, as well as information on its ultrasonographic appearance in clinically healthy adult cats. We did not find any correlation between the age of the cats and the size of the papilla, but the age range was small and another study in older cats should be undertaken to address this more thoroughly.
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Affiliation(s)
- Charlotte Coeuriot
- Department of Medical Imaging, Oniris, Nantes-Atlantic College of Veterinary Medicine Food Sciences and Engineering, Nantes, Cedex 3, France
| | - Julie Pontarrasse
- Department of Medical Imaging, Oniris, Nantes-Atlantic College of Veterinary Medicine Food Sciences and Engineering, Nantes, Cedex 3, France
| | - Nora Bouhsina
- Department of Medical Imaging, Oniris, Nantes-Atlantic College of Veterinary Medicine Food Sciences and Engineering, Nantes, Cedex 3, France
| | - Maureen Lazard
- Department of Medical Imaging, Oniris, Nantes-Atlantic College of Veterinary Medicine Food Sciences and Engineering, Nantes, Cedex 3, France
| | - Alexis Bertrand
- Department of Medical Imaging, Oniris, Nantes-Atlantic College of Veterinary Medicine Food Sciences and Engineering, Nantes, Cedex 3, France
| | - Marion Fusellier
- Department of Medical Imaging, Oniris, Nantes-Atlantic College of Veterinary Medicine Food Sciences and Engineering, Nantes, Cedex 3, France
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Liu SZ, Chai NL, Li HK, Feng XX, Zhai YQ, Wang NJ, Gao Y, Gao F, Wang SS, Linghu EQ. Prospective single-center feasible study of innovative autorelease bile duct supporter to delay adverse events after endoscopic papillectomy. World J Clin Cases 2022; 10:7785-7793. [PMID: 36158476 PMCID: PMC9372830 DOI: 10.12998/wjcc.v10.i22.7785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/18/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Conventional endoscopic papillectomy (EP) is safe and effective for the treatment of small papilla adenoma to even large laterally spreading tumors of duodenum lesions. As reported by some existing studies, temporarily placing a prophylactic stent in the pancreatic and bile duct can lower the risk of this perioperative complication.
AIM To evaluate the usefulness, convenience, safety, and short-term results of a novel autorelease bile duct supporter after EP procedure, especially the effectiveness in preventing EP.
METHODS A single-center comparison study was conducted to verify the feasibility of the novel method. After EP, a metallic endoclip and human fibrin sealant kit were applied for protection. The autorelease bile duct supporter fell into the duct segment and the intestinal segment. Specifically, the intestinal segment was extended by nearly 5 cm as a bent coil. The bile was isolated from the pancreatic juice using an autorelease bile duct supporter, which protected the wound surface. The autorelease bile duct supporter fell off naturally and arrived in colon nearly 10 d after the operation.
RESULTS En bloc endoscopic resection was performed in 6/8 patients (75%), and piecemeal resection was performed in 2/8 of patients (25%). None of the above patients were positive for neoplastic lymph nodes or distant metastasis. No cases of mortality, hemorrhage, delayed perforation, pancreatitis, cholangitis or duct stenosis with the conventional medical treatment were reported. The autorelease bile duct supporter in 7 of 8 patients fell off naturally and arrived in colon 10 d after the operation. One autorelease bile duct supporter was successfully removed using forceps or snare under endoscopy. No recurrence was identified during the 8-mo (ranging from 6-9 mo) follow-up period.
CONCLUSION In brief, it was found that the autorelease bile duct supporter could decrease the frequency of procedure-associated complications without second endoscopic retraction. Secure closure of the resection wound with clips and fibrin glue were indicated to be promising and important for the use of autorelease bile duct supporters. Well-designed larger-scale comparative studies are required to confirm the findings of this study.
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Affiliation(s)
- Sheng-Zhen Liu
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
| | - Ning-Li Chai
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
| | - Hui-Kai Li
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
| | - Xiu-Xue Feng
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
| | - Ya-Qi Zhai
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
| | - Nan-Jun Wang
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
| | - Ying Gao
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
| | - Fei Gao
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
| | - Sha-Sha Wang
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
| | - En-Qiang Linghu
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
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Li M, Wang A, Ren S, Wang Z, Wang Q, Gou C, Zhao W, Zhang L, Li N. Factors associated with acute pancreatitis in patients with impacted duodenal papillary stones: a retrospective cohort study. Scand J Gastroenterol 2022; 57:896-903. [PMID: 35297730 DOI: 10.1080/00365521.2022.2050294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Impaction of a stone at the duodenal papilla can obstruct biliopancreatic outflow and thereby lead to acute pancreatitis. But not all patients with an impacted papillary stone (IPS) had the clinical features of pancreatitis. This study aimed to identify factors associated with acute pancreatitis in patients with IPS. METHODS We retrospectively analyzed patients with IPS who underwent endoscopic retrograde cholangiopancreatography (ERCP) at Tianjin Nankai Hospital. Clinical factors were compared between patients with/without acute pancreatitis before ERCP. Factors associated with acute pancreatitis were identified by univariable and multivariable binary logistic regression. RESULTS The final analysis included 174 patients with acute pancreatitis (pancreatitis group, PG) and 130 patients without acute pancreatitis (non-pancreatitis group, NPG). Preoperative incidences of jaundice (85.6 vs. 72.3%), acute cholangitis (54.6 vs. 33.8%), and hyperlipidemia (39.1 vs. 22.3%) were higher in the PG than in the NPG (p < .05). High tension in the duodenal papilla (83.3 vs. 71.5%), circular papillary orifice (82.8 vs. 70.0%), and distal stone impaction (90.8 vs. 82.3%) were more common in the PG than in the NPG (p < .05), whereas stone diameter and common bile duct diameter did not differ significantly between groups. Multivariable logistic regression revealed that jaundice, acute cholangitis, hyperlipidemia, and dot/circular papillary orifice were independently associated with acute pancreatitis (p < .05). CONCLUSIONS Jaundice, acute cholangitis, and hyperlipidemia are independent risk factors for acute pancreatitis in patients with IPS. Prompt ERCP in patients with these features might reduce acute pancreatitis risk. Dot/circular papillary orifice may be an anatomical factor of acute pancreatitis, which needs more evidence.
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Affiliation(s)
- Ming Li
- Department of Hepatopancreatobiliary Surgery, Tianjin Medical University NanKai Hospital, Tianjin, China
| | - Ao Wang
- Tianjin Medical University, Tianjin, China
| | | | - Zhenyu Wang
- Endoscopy Center, Integrated Chinese and Western Medicine Hospital, Tianjin University, Tianjin, China.,Department of Hepatopancreatobiliary Surgery, Integrated Chinese and Western Medicine Hospital, Tianjin University, Tianjin, China
| | - Qing Wang
- Endoscopy Center, Integrated Chinese and Western Medicine Hospital, Tianjin University, Tianjin, China.,Department of Hepatopancreatobiliary Surgery, Integrated Chinese and Western Medicine Hospital, Tianjin University, Tianjin, China
| | - Chengyue Gou
- Endoscopy Center, Integrated Chinese and Western Medicine Hospital, Tianjin University, Tianjin, China.,Department of Hepatopancreatobiliary Surgery, Integrated Chinese and Western Medicine Hospital, Tianjin University, Tianjin, China
| | - Weichuan Zhao
- Endoscopy Center, Integrated Chinese and Western Medicine Hospital, Tianjin University, Tianjin, China
| | - Li Zhang
- Endoscopy Center, Integrated Chinese and Western Medicine Hospital, Tianjin University, Tianjin, China
| | - Ning Li
- Endoscopy Center, Integrated Chinese and Western Medicine Hospital, Tianjin University, Tianjin, China.,Department of Hepatopancreatobiliary Surgery, Integrated Chinese and Western Medicine Hospital, Tianjin University, Tianjin, China
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Wang J, Han J, Xu H, Tai S, Xie X. Primary duodenal papilla lymphoma producing obstructive jaundice: a case report. BMC Surg 2022; 22:110. [PMID: 35321694 PMCID: PMC8944164 DOI: 10.1186/s12893-022-01558-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/14/2022] [Indexed: 12/02/2022] Open
Abstract
Background Obstructive jaundice caused by primary duodenal lymphoma is a rare disease. Case presentation We reported a 59-year-old man who underwent endoscopic ultrasonography for obstructive jaundice and found a duodenal papilla tumor. Light microscopy revealed a non-Hodgkin's lymphoma. Immunohistochemical staining showed that the tumor was aggressive B-cell lymphoma. We carried out molecular targeted therapy combined with CHOP regimen chemotherapy. Conclusion Surgery plays an important role in resolving obstructive jaundice when accurate histological diagnosis cannot be made. After diagnosis, chemotherapy should play a central role in treatment.
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Affiliation(s)
- Jicai Wang
- Department of Hepatopancreatobiliary, Thyroid and Vascular Surgery, Wuhan Third Hospital (Tongren Hospital of Wuhan University), No. 241 Pengliuyang Road, Wuchang, Wuhan, 430060, Hubei, China.
| | - Jiantao Han
- Department of Hepatopancreatobiliary, Thyroid and Vascular Surgery, Wuhan Third Hospital (Tongren Hospital of Wuhan University), No. 241 Pengliuyang Road, Wuchang, Wuhan, 430060, Hubei, China
| | - Hanbing Xu
- Department of Hepatopancreatobiliary, Thyroid and Vascular Surgery, Wuhan Third Hospital (Tongren Hospital of Wuhan University), No. 241 Pengliuyang Road, Wuchang, Wuhan, 430060, Hubei, China
| | - Sheng Tai
- Department of Hepatic Surgery, The Second Affiliated Hospital of Harbin Medical University, No. 246 XueFu Avenue, Harbin, 150086, Heilongjiang, China
| | - Xingwang Xie
- Department of Hepatopancreatobiliary, Thyroid and Vascular Surgery, Wuhan Third Hospital (Tongren Hospital of Wuhan University), No. 241 Pengliuyang Road, Wuchang, Wuhan, 430060, Hubei, China
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Dar HA, Shah A, Javid G, Khan MA, Singh B, Sheikh NA, Ashraf A, Mohammad S. Randomized trial of high-dose rectal diclofenac suppository and epinephrine spray on duodenal papilla for prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis. Indian J Gastroenterol 2021; 40:483-491. [PMID: 34767149 DOI: 10.1007/s12664-021-01161-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 02/22/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS High-dose rectal diclofenac suppository and epinephrine spray on duodenal papilla during endoscopic retrograde cholangiopancreatography (ERCP) may reduce the incidence of post-ERCP pancreatitis. We performed randomized trial to compare the effect of combination of rectal diclofenac and epinephrine spray on papilla (group A) vs. combination of rectal diclofenac with saline spray (group B) for prevention of post-ERCP pancreatitis. METHODS We performed a double-blind trial at tertiary care center from April 2018 to May 2020 on 882 patients with naive papilla undergoing ERCP. The patients were randomly assigned to groups, A (n=437) or B (n=445). All patients received a single dose of rectal diclofenac 100 mg within 30 minutes before ERCP; 20 mL of diluted epinephrine 0.02% (group A) or saline (group B) was then sprayed on the duodenal papilla at the end of ERCP. The primary outcome was to compare incidence of post-ERCP pancreatitis (PEP) in two groups. RESULTS The groups had similar baseline characteristics. PEP developed in 28 patients in group A (6.4%) and 35 patients in group B (7.9%) (relative risk, 1.1; 95% CI, 0.87-1.39; p=0.401). CONCLUSION Our study showed that addition of epinephrine spray on duodenal papilla did not reduce the risk of post-ERCP pancreatitis. There is need for further studies to evaluate the role of different concentrations of epinephrine spray on papilla for prevention of post-ERCP pancreatitis. TRIAL REGISTRATION Clinical Trials Registry- India (CTRI/2018/04/013396).
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Affiliation(s)
- Hilal Ahmad Dar
- Department of Gastroenterology, Sher- i- Kashmir Institute of Medical Sciences, Srinagar, Kashmir, 190 011, India. .,Department of Internal Medicine, Government Medical College, Baramulla, Kashmir, 193 101, India.
| | - Altaf Shah
- Department of Gastroenterology, Sher- i- Kashmir Institute of Medical Sciences, Srinagar, Kashmir, 190 011, India
| | - Gul Javid
- Department of Gastroenterology, Sher- i- Kashmir Institute of Medical Sciences, Srinagar, Kashmir, 190 011, India
| | - Mushtaq Ahmad Khan
- Department of Gastroenterology, Sher- i- Kashmir Institute of Medical Sciences, Srinagar, Kashmir, 190 011, India
| | - Bhagat Singh
- Department of Gastroenterology, Sher- i- Kashmir Institute of Medical Sciences, Srinagar, Kashmir, 190 011, India
| | - Nadeem Ahmad Sheikh
- Department of Gastroenterology, Sher- i- Kashmir Institute of Medical Sciences, Srinagar, Kashmir, 190 011, India
| | - Aadil Ashraf
- Department of Gastroenterology, Sher- i- Kashmir Institute of Medical Sciences, Srinagar, Kashmir, 190 011, India
| | - Sozia Mohammad
- Department of Microbiology, Sher- i- Kashmir Institute of Medical Sciences, Srinagar, Kashmir, 190 011, India
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Nakamura M, Otsuka T, Hayashi R, Horita T, Ota M, Sakurai N, Takano H, Hayashi T, Miura S, Ueda N, Takamura H, Arisawa T. Dissection and removal of bile duct plastic stents penetrating the duodenal papilla: report of three rare cases. Clin J Gastroenterol 2021; 14:1255-1262. [PMID: 34002284 DOI: 10.1007/s12328-021-01435-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/02/2021] [Indexed: 11/28/2022]
Abstract
We encountered three cases with incidental penetration of a straight Amsterdam-type bile duct plastic stent into the duodenal papilla. All patients had undergone insertion of a biliary plastic stent due to common bile duct stones. However, in all three cases, we observed penetration of the biliary plastic stent into the duodenal papilla just before the elective surgery or at the time of plastic stent replacement. We, therefore, performed stent dissection using a bipolar snare and were able to safely remove the plastic stents in all three cases. We believe that this is the first report of plastic stent dissection using a bipolar snare.
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Affiliation(s)
- Masakatsu Nakamura
- Department of Gastroenterology, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Ishikawa, 920-0293, Japan.
| | - Toshimi Otsuka
- Department of Gastroenterology, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Ishikawa, 920-0293, Japan
| | - Ranji Hayashi
- Department of Gastroenterology, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Ishikawa, 920-0293, Japan
| | - Tomoe Horita
- Department of Gastroenterology, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Ishikawa, 920-0293, Japan
| | - Masafumi Ota
- Department of Gastroenterology, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Ishikawa, 920-0293, Japan
| | - Naoko Sakurai
- Department of Gastroenterology, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Ishikawa, 920-0293, Japan
| | - Hikaru Takano
- Department of Gastroenterology, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Ishikawa, 920-0293, Japan
| | - Tasuku Hayashi
- Department of Gastroenterology, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Ishikawa, 920-0293, Japan
| | - Seiko Miura
- Department of Surgical Oncology, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Ishikawa, 920-0293, Japan
| | - Nobuhiko Ueda
- Department of Surgical Oncology, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Ishikawa, 920-0293, Japan
| | - Hiroyuki Takamura
- Department of Surgical Oncology, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Ishikawa, 920-0293, Japan
| | - Tomiyasu Arisawa
- Department of Gastroenterology, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Ishikawa, 920-0293, Japan
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Yi L, Cheng Z, Zhou Y, Wang Q, Liu Y, Liu K, Wang T, Zhong X. Fishbone foreign body ingestion in duodenal papilla: a cause of abdominal pain resembling gastric ulcer. BMC Gastroenterol 2020; 20:323. [PMID: 33008291 PMCID: PMC7532595 DOI: 10.1186/s12876-020-01475-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 09/28/2020] [Indexed: 12/30/2022] Open
Abstract
Background Foreign body ingestion is a common clinical problem. The upper esophagus is the most common site of foreign body, accounting for more than 75% of all cases, but cases with a foreign body in the duodenal papilla or common bile duct are rarely reported. Case presentation Herein, we report a rare case that a patient’s abdominal pain resembling gastric ulcer was caused by a 3 cm long fishbone inserted into the duodenal papilla. Conclusion Fishbone inserted into the duodenal papilla can cause an abdominal pain resembling gastric ulcer. Endoscopy is useful for the diagnosis and treatment of fishbone ingestion in clinical.
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Affiliation(s)
- Lizhi Yi
- Department of Gastroenterology, People's Hospital of Leshan, Leshan, Sichuan, People's Republic of China.
| | - Zhengyu Cheng
- Department of Gastroenterology, People's Hospital of Leshan, Leshan, Sichuan, People's Republic of China
| | - Yafei Zhou
- Department of Anesthesiology, People's Hospital of Leshan, Leshan, Sichuan, People's Republic of China
| | - Qin Wang
- Department of Gastroenterology, People's Hospital of Leshan, Leshan, Sichuan, People's Republic of China
| | - Yangyang Liu
- Department of Gastroenterology, People's Hospital of Leshan, Leshan, Sichuan, People's Republic of China
| | - Ke Liu
- Department of Gastroenterology, People's Hospital of Leshan, Leshan, Sichuan, People's Republic of China
| | - Tao Wang
- Department of Radiology, People's Hospital of Leshan, Leshan, Sichuan, People's Republic of China
| | - Xianfei Zhong
- Department of Gastroenterology, People's Hospital of Leshan, Leshan, Sichuan, People's Republic of China
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Li S, Wang Z, Cai F, Linghu E, Sun G, Wang X, Meng J, Du H, Yang Y, Li W. New experience of endoscopic papillectomy for ampullary neoplasms. Surg Endosc 2018; 33:612-619. [PMID: 30421083 DOI: 10.1007/s00464-018-6577-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 11/02/2018] [Indexed: 12/15/2022]
Abstract
AIM To establish the clinical value of endoscopic papillectomy for duodenal papillary tumor based on endoscopic and clinical characteristics. PATIENTS AND METHODS This single-center, retrospective study included 110 patients with duodenal papillary tumor who underwent endoscopic papillectomy between January 2006 and April 2017 at the gastrointestinal endoscopic center of the Chinese PLA General Hospital. Clinical data, postoperative pathology, procedure-related complications, and therapeutic outcomes were analyzed. RESULTS Endoscopic papillectomy was technically feasible in all patients, and was mainly performed by four experienced endoscopists. The primary success rate of endoscopic papillectomy for ampullary neoplasms was 78.2%. A total of 13 patients experienced recurrence during a mean follow-up period of 16.28 months (range 6-132 months), the predictive factors that were related to recurrence were complete resection (53.8% vs. 94.2%; P = 0.001), and final pathology findings (P = 0.001). Delayed hemorrhage, the most common procedure-related complication, occurred in 20% (22/110) of patients and was significantly related to intraoperative bleeding (P = 0.042). Pancreatitis was the second most common complication, which was closely related to intraoperative bleeding requiring intervention (P = 0.040) and larger tumor size (P = 0.044). Histology, type of resection, stent placement, sphincterotomy, and duration of procedure were not related to post-procedure hemorrhage or pancreatitis. Older age (63.7 ± 13.5 vs. 57.4 ± 12.2; P = 0.033), jaundice (47.8% vs. 13.8%; P = 0.001), endoscopic forceps biopsy diagnosis of high-grade intraepithelial neoplasia (82.6% vs. 14.9%; P = 0.001), tumor size ≥ 2 cm (60.9% vs. 34.5%; P = 0.022), and dilation of the bile duct (34.8% vs. 9.2%; P = 0.006) were clinical features for ampullary carcinoma. The rate of complete resection (52.2% vs. 92.0%; P = 0.001) and recurrence (34.8% vs. 6.8%; P = 0.001) were also related to the diagnosis of ampullary carcinoma at final pathology. CONCLUSIONS Endoscopic papillectomy is a feasible and reasonable option for both diagnosis and treatment of tumors of the duodenal papilla in properly selected patients.
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Affiliation(s)
- Shuling Li
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, 28#, Fuxing Road, Beijing, 100853, China
| | - Zikai Wang
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, 28#, Fuxing Road, Beijing, 100853, China
| | - Fengchun Cai
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, 28#, Fuxing Road, Beijing, 100853, China
| | - Enqiang Linghu
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, 28#, Fuxing Road, Beijing, 100853, China
| | - Gang Sun
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, 28#, Fuxing Road, Beijing, 100853, China
| | - Xiangdong Wang
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, 28#, Fuxing Road, Beijing, 100853, China
| | - Jiangyun Meng
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, 28#, Fuxing Road, Beijing, 100853, China
| | - Hong Du
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, 28#, Fuxing Road, Beijing, 100853, China
| | - Yunsheng Yang
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, 28#, Fuxing Road, Beijing, 100853, China
| | - Wen Li
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, 28#, Fuxing Road, Beijing, 100853, China.
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Latorre R, López-Albors O, Soria F, Candanosa E, Pérez-Cuadrado E. Effect of the manipulation of the duodenal papilla during double balloon enteroscopy. World J Gastroenterol 2016; 22:4330-4337. [PMID: 27158201 PMCID: PMC4853690 DOI: 10.3748/wjg.v22.i17.4330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 02/11/2016] [Accepted: 03/02/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the hypothesis that inflating the balloons in the duodenal papilla determines changes in the biochemical markers of pancreatitis.
METHODS: Four groups of pigs were used: Group papilla (GP), the overtube’s balloon was inflated in the area of the papilla; GP + double balloon enteroscopy (GP + DBE), the overtube’s balloon was kept inflated in the area of the papilla for 20 min before a DBE; Group DBE (GDBE), DBE was carried out after insuring the balloon’s inflation far from the pancreatic papilla; and Group control (GC). Serum concentrations of amylase, lipase and C-reactive protein (CRP) were evaluated. Pancreases were processed for histopathology examination.
RESULTS: Main changes occurred 24 h after the procedure compared with baseline levels. Amylase levels increased significantly in GP (59.2% higher) and were moderately higher in groups GP + DBE and GDBE (22.7% and 20%, respectively). Lipase increased in GP and GP + DBE, whereas it hardly changed in GDBE and in GC. CRP increased significantly in GP, GP + DBE and GDBE, while no changes were reported for GC. No statistically significant difference between groups GP and GP + DBE was found for the histopathological findings, except for vacuolization and necrosis of the pancreatic parenchyma that was higher in GP than in GP + DBE.
CONCLUSION: The manipulation of the duodenal papilla by the inflated overtube’s balloon during DBE causes pancreatic structural damage and increased biochemical markers associated with pancreatitis.
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Kawamoto Y, Ome Y, Terada K, Hashida K, Kawamoto K, Ito T. Undifferentiated carcinoma with osteoclast-like giant cells of the ampullary region: Short term survival after pancreaticoduodenectomy. Int J Surg Case Rep 2016; 24:199-202. [PMID: 27281360 PMCID: PMC4906136 DOI: 10.1016/j.ijscr.2016.04.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 04/25/2016] [Accepted: 04/29/2016] [Indexed: 12/23/2022] Open
Abstract
A rare case of undifferentiated carcinomas with osteoclast-like giant cells of the ampullary region successfully treated with pancreaticoduodenectomy. Carcinoma in situ was also observed, spreading from the tumor at the terminal segment of the common bile duct to the surgical margin of the common hepatic duct. It is important to intraoperatively confirm negative bile duct margins by rapid pathologic diagnosis.
Introduction Undifferentiated carcinomas with osteoclast-like giant cells (UC-OGCs) of the ampullary region are very rare, with only a few cases reported to date. The clinicopathological features, treatment options, and prognosis of UC-OGCs are unclear. This report describes a patient with UC-OGCs of the ampullary region. Presentation of case A 78-year-old male patient was admitted for epigastric pain and fever. Contrast-enhanced computed tomography revealed a 2.6-cm mass at the duodenal papilla. Duodenoscopy revealed a smooth red protruding mass compressing the orifice of the papilla of Vater. Biopsy of the mass showed proliferation of osteoclast-like giant cells. A subtotal stomach-preserving pancreaticoduodenectomy was performed, and the tumor was histologically diagnosed as an UC-OGCs of the ampullary region. Carcinoma in situ was also observed, spreading from the tumor at the terminal segment of the common bile duct to the common hepatic duct, with carcinoma cells at the surgical margin of the common hepatic duct. One year after surgery, the patient is alive and without tumor recurrence. Discussion UC-OGCs of the ampullary region is very rare neoplasm containing osteoclast-like giant cells and mononuclear cells. Osteoclast-like giant cells may originate from reactive mesenchymal cells and carcinoma in situ may spread to the common hepatic duct. Surgery including pancreaticoduodenectomy may be a treatment option for resectable tumors, whereas gemcitabine may be a treatment option for unresectable tumors. Conclusion Carcinoma in situ may spread quite far (5 cm) to the common hepatic duct, making it desirable to intraoperatively confirm negative bile duct margins by rapid pathologic diagnosis.
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Affiliation(s)
- Yusuke Kawamoto
- Department of Surgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan.
| | - Yusuke Ome
- Department of Surgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan.
| | - Kazuhiro Terada
- Department of Diagnostic Pathology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan.
| | - Kazuki Hashida
- Department of Surgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan.
| | - Kazuyuki Kawamoto
- Department of Surgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan.
| | - Tadashi Ito
- Department of Surgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan.
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Kawaguchi Y, Kawashima Y, Maruno A, Ito H, Ogawa M, Izumi H, Furukawa D, Yazawa N, Nakagori T, Hirabayashi K, Mine T. An intraductal papillary neoplasm of the bile duct at the duodenal papilla. Case Rep Oncol 2014; 7:417-21. [PMID: 25126070 PMCID: PMC4130820 DOI: 10.1159/000364999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
In recent years, the disease concept of intraductal papillary neoplasm of the bile duct (IPNB) has been attracting attention as a biliary lesion that is morphologically similar to intraductal papillary mucinous neoplasm (IPMN), which is considered to be a counterpart of IPMN. However, there are few reports on IPNB, and a consensus regarding the features of this disease is thus lacking. We experienced an extremely rare case of IPNB occurring in the bile duct at the duodenal papilla, which is a tumor presentation that has not previously been reported. Herein, we report this interesting case and discuss the possible association between IPMN and IPNB.
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Affiliation(s)
- Yoshiaki Kawaguchi
- Department of Gastroenterology, Tokai University School of Medicine, Isehara, Japan
| | - Yohei Kawashima
- Department of Gastroenterology, Tokai University School of Medicine, Isehara, Japan
| | - Atsuko Maruno
- Department of Gastroenterology, Tokai University School of Medicine, Isehara, Japan
| | - Hiroyuki Ito
- Department of Gastroenterology, Tokai University School of Medicine, Isehara, Japan
| | - Masami Ogawa
- Department of Gastroenterology, Tokai University School of Medicine, Isehara, Japan
| | - Hideki Izumi
- Department of Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Daisuke Furukawa
- Department of Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Naoki Yazawa
- Department of Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Toshio Nakagori
- Department of Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Kenichi Hirabayashi
- Department of Pathology, Tokai University School of Medicine, Isehara, Japan
| | - Tetsuya Mine
- Department of Gastroenterology, Tokai University School of Medicine, Isehara, Japan
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12
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Chini P, Draganov PV. Diagnosis and management of ampullary adenoma: The expanding role of endoscopy. World J Gastrointest Endosc 2011; 3:241-7. [PMID: 22195233 PMCID: PMC3244941 DOI: 10.4253/wjge.v3.i12.241] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Revised: 08/21/2011] [Accepted: 08/28/2011] [Indexed: 02/05/2023] Open
Abstract
Ampullary adenoma is a pre-cancerous lesion arising from the duodenal papilla that is often asymptomatic. It is important to distinguish whether the adenoma is sporadic or arises in the setting of familial adenomatous polyposis as this has important implications with respect to management and surveillance. Multiple modalities are available for staging of these lesions to help guide the most appropriate therapy. Those that are used most commonly include computed tomography, endoscopic ultrasound, and endoscopic retrograde cholangiopancreatography. In recent years, endoscopy has become the primary modality for therapeutic management of the majority of ampullary adenomas. Surgery remains the standard curative procedure for confirmed or suspected adenocarcinoma. This review will provide the framework for the diagnosis and management of ampullary adenomas from the perspective of the practicing gastroenterologist.
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Affiliation(s)
- Payam Chini
- Payam Chini, Peter V Draganov, Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, FL 32610, United States
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Abstract
We encountered a 65-year-old man with a carcinoid tumor of the minor duodenal papilla. Since he had liver cirrhosis and completely refused surgery, we performed an endoscopic snare papillectomy. The papillectomy was performed successfully without procedure-related complication. The specimens revealed a carcinoid tumor showing that the margin of the tumor was positive. One week later, upper GI endoscopy was performed and the biopsy specimens obtained from base of ulcer showed no neoplastic cells. We performed a duodenoscopy and CT 3, 6 and 18 mo later, and there was no macroscopic or microscopic evidence of tumor recurrence after more than 4 years.
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Affiliation(s)
- Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University Shinjuku-ku, Nishishinjuku 6-7-1, Tokyo, Japan.
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