摘要
In the majority of cases, duodenal papillary tumors are adenomas or adenocarcinomas, but the endoscopy biopsy shows low accuracy to make the correct differentiation. Endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography are important tools for the diagnosis, staging and management of ampullary lesions. Although the endoscopic papillectomy(EP) represent higher risk endoscopic interventions, it has successfully replaced surgical treatment for benign or malignant papillary tumors. The authors review the epidemiology and discuss the current evidence for the use of endoscopic procedures for resection, the selection of the patient and the preventive maneuvers that can minimize the probability of persistent or recurrent lesions and to avoid complications after the procedure. The accurate staging of ampullary tumors is important for selecting patients to EP or surgical treatment. Compared to surgery, EP is associated with lower morbidity and mortality, and seems to be a preferable modality of treatment for small benign ampullary tumors with no intraductal extension. The EP procedure, when performed by an experienced endoscopist, leads to successful eradication in up to 85% of patients with ampullary adenomas. EP is a safe and effective therapy and should be established as the first-line therapy for ampullary adenomas.
In the majority of cases, duodenal papillary tumorsare adenomas or adenocarcinomas, but the endoscopybiopsy shows low accuracy to make the correct differentiation.Endoscopic ultrasonography and endoscopicretrograde cholangiopancreatography are importanttools for the diagnosis, staging and managementofampullary lesions. Although the endoscopic papillectomy（EP） represent higher risk endoscopic interventions, ithas successfully replaced surgical treatment for benignor malignant papillary tumors. The authors review theepidemiology and discuss the current evidence forthe use of endoscopic procedures for resection, theselection of the patient and the preventive maneuversthat can minimize the probability of persistent orrecurrent lesions and to avoid complications after theprocedure. The accurate staging of ampullary tumorsis important for selecting patients to EP or surgicaltreatment. Compared to surgery, EP is associatedwith lower morbidity and mortality, and seems to bea preferable modality of treatment for small benignampullary tumors with no intraductal extension. TheEP procedure, when performed by an experiencedendoscopist, leads to successful eradication in up to85% of patients with ampullary adenomas. EP is a safeand effective therapy and should be established as thefirst-line therapy for ampullary adenomas.
