Laparoscopic transduodenal local resection of periampullary neuroendocrine tumor: A case report

Studies on laparoscopic transduodenal local resection have not been readily available.Only three cases have been reported in the English-language literature.We describe herein a case of 25-year-old woman with periampullary neuroendocrine tumor(NET).Endoscopic ultrasonography revealed a duodenal papilla mass originated from the submucosa and close to the ampulla.The periampullary tumor was successfully managed with laparoscopic transduodenal local resection without any procedure-related complications.Pathological examination showed a NET(Grade 2)with negative margin.The patient was followed up for six months without signs of recurrence.This case suggests that laparoscopic transduodenal local resection is a feasible procedure in selected patients with periampullary tumor.

Surgical method choice and coincidence rate of pathological diagnoses in transduodenal ampullectomy: A retrospective case series study and review of the literature

BACKGROUND Transduodenal ampullectomy(TDA) is not in wide clinical use due to its low radical effect and a high recurrence rate of tumors. However,TDA is still an effective treatment method; it has great clinical value in cases of duodenal benign tumors,precancerous lesions,and benign and malignant borderline tumors,and can avoid the risks associated with pancreaticoduodenectomy with larger resection range and greater thoroughness than endoscopic papillectomy.AIM To investigate the surgical method choice and the coincidence rate of pathological diagnoses in TDA for ampullary neoplasms.METHODS Ten patients with ampullary neoplasms underwent TDA based on the fact that their endoscopic biopsy results suggested benign lesions,and the endoscopic ultrasound(EUS)-assessed tumors were resectable. All cases underwent duodenal ampullary lesion endoscopic biopsy,intraoperative frozen-section pathological examination,and postoperative pathological examination.RESULTSThis study included seven patients with benign tumors and three with malignant tumors(1 pTis,2 pT1),according to the postoperative pathology results. The coincidence rate of the postoperative pathology results with the intraoperative frozen-section biopsy results was 100%(10/10),and the coincidence rate with the endoscopic biopsy results was 70%(7/10) based on pathological characteristics.The endoscopic biopsy false-negative rate was 30%(3/10). All patients were followed for 6 to 70 mo without tumor recurrence or metastasis.CONCLUSION The coincidence rate of postoperative pathology results,intraoperative frozensection pathology results,and endoscopic biopsy results is the restraining factor of TDA clinical application. Endoscopic biopsy results and EUS have importance relevance to surgical planning. Intraoperative frozen-section pathology results have a significant influence on the choice of surgical procedure.

Microscopic transduodenal excision of an ampullary adenoma:A case report and review of the literature

BACKGROUND Transduodenal local excision is an alternative treatment approach for benign ampullary tumors.However,this procedure has technical difficulties,especially during reconstruction of the pancreaticobiliary ducts.An operating microscope has been widely used by surgeons for delicate surgery due to its major advantages of magnification,illumination,and stereoscopic view.The application of an operating microscope in transduodenal excision of ampullary tumors has not been reported.CASE SUMMARY A 55-year-old woman was admitted for investigation of recurrent upper abdominal pain.Physical examination and laboratory tests found no abnormalities.Imaging identified a large mass in the descending part of the duodenum.Esophagogastroduodenoscopy revealed a 3.5-cm-sized villous growth over the major duodenal papilla.Pathology of the endoscopic biopsy indicated a villous adenoma with low-grade dysplasia.Microscopic transduodenal excision of the ampullary tumor was performed.The final pathological diagnosis was villous-tubular adenoma with low-grade dysplasia.The patient was discharged on postoperative day 12 after an uneventful recovery.Endoscopic retrograde cholangiopancreatography was performed 3 mo postoperatively and showed no bile duct or pancreatic duct strictures and no tumor recurrence.The patient is continuing follow-up at our clinic and remains well.CONCLUSION Operating microscope-assisted transduodenal local excision is a feasible and effective option for benign ampullary tumors.

Postprandial transduodenal bolus transport is regulated by complex peristaltic sequence

AIM: To study the relationship between the patterns of postprandial peristalsis and transduodenal bolus transport in healthy subjects. METHODS: Synchronous recording of chyme transport and peristaltic activity was performed during the fasting state and after administration of a test meal using a special catheter device with cascade configuration of impedance electrodes and solid-state pressure transducers. The catheter was placed into the duodenum, where the f irst channel was located in the f irst part of the duodenum and the last channel at the duodenojejunal junction. After identif ication of previously def ined chyme transport patterns the associated peristaltic patterns were analyzed. RESULTS: The interdigestive phase 3 complex was reliably recorded with both techniques. Of 497 analyzed impedance bolus transport events, 110 (22%) were short-spanned propulsive, 307 (62%) long-spanned propulsive, 70 (14%) complex propulsive, and 10 (2%) retrograde transport. Short-spanned chyme transports were predominantly associated with stationary or propagated contractions propagated over short distance. Long-spanned and complex chyme transports were predominantly associated with propulsive peristaltic patterns, which were frequently complex and comprised multiple contractions. Propagated double wave contraction, propagated contraction with a clustered contraction, and propagated cluster of contractions have been identif ied to be an integralted part of a peristaltic sequence in human duodenum. CONCLUSION: Combined impedancometry and manometry improves the analysis of the peristaltic patterns that are associated with postprandial transduodenal chymetransport. Postprandial transduodenal bolus transport is regulated by propulsive peristaltic patterns, which are frequently complex but well organized. This f inding should be taken into consideration in the analysis of intestinal motility studies.

Surgical ampullectomy:A comprehensive review

Tumours of the ampulla of Vater are relatively uncommon lesions of the digestive system.They are typically diagnosed at an earlier stage than other types of tumours in this region,due to their tendency to invoke symptoms by obstructing the bile duct or pancreatic duct.Consequently,many are potentially curable by excision.Surgical ampullectomy(SA)(or transduodenal ampullectomy)for an ampullary tumour was first described in 1899,but was soon surpassed by pancreatoduodenectomy(PD),which offered a more extensive resection resulting in a lower risk of recurrence.Ongoing innovation in endoscopic techniques over recent decades has led to the popularization of endoscopic papillectomy(EP),particularly for adenomas and even early cancers.The vast majority of resectable ampullary tumours are now treated using either PD or EP.However,SA continues to play a role in specific circumstances.Many authors have suggested specific indications for SA based on their own data,practices,or interpretations of the literature.However,certain issues have attracted controversy,such as its use for early ampullary cancers.Consequently,there has been a lack of clarity regarding indications for SA,and no evidence-based consensus guidelines have been produced.All studies reporting SA have employed observational designs,and have been heterogeneous in their methodologies.Accordingly,characteristics of patients and their tumours have differed substantially across treatment groups.Therefore,meaningful comparisons of clinical outcomes between SA,PD and EP have been elusive.Nevertheless,it appears that suitably selected cases of ampullary tumours subjected to SA may benefit from favourable peri-operative and long-term outcomes with very low mortality and significantly long survival,hence its role in this setting warrants further clarification,while it can also be useful in the management of specific benign entities.Whilst the commissioning of a randomised controlled trial seems unlikely,well-designed observational studies incorporating adjustments for confounding variables may become the best available comparative evidence for SA,potentially informing the eventual development of consensus guidelines.In this comprehensive review,we explore the role of SA in the modern management of ampullary lesions.

Comparison of trans-gastric vs trans-enteric(trans-duodenal or trans-jejunal)endoscopic ultrasound guided gallbladder drainage using lumen apposing metal stents

BACKGROUND Endoscopic ultrasound guided gallbladder drainage(EUS-GBD)is being increasingly used in practice(either as a bridge to cholecystectomy in high-risk patients or as destination therapy in non-surgical patients).Stents are used to create a conduit between the lumen of the gallbladder(GB)and the intestinal lumen through the gastric or enteric routes.Among the various types of stents used,cautery-enhanced lumen apposing metallic stents(LAMS)may be associated with fewer adverse events(AEs).AIM To compare the clinical success,technical success,and rate of AEs between transgastric(TG)and trans-enteric[transduodenal(TD)/transjejunal(TJ)]approach to GB drainage.Further,we analyzed whether using cautery enhanced stents during EUS-GBD impacts the above parameters.METHODS Study was registered in PROSPERO(CRD42022319019)and comprehensive literature review was conducted.Manuscripts were reviewed for the data collection:Rate of AEs,clinical success,and technical success.Random effects model was utilized for the analysis.RESULTS No statistically significant difference in clinical and technical success between the TD/TJ and TG approaches(P>0.05)were noted.There was no statistically significant difference in the rate of AEs when comparing two-arm studies only.However,when all studies were included in the analysis difference was almost significant favoring the TD/TJ approach.When comparing cautery-enhanced LAMS with non-cautery enhanced LAMS,a statistically significant difference in the rate of AEs was observed when all the studies were included,with the rate being higher in non-cautery enhanced stents(14.0%vs 37.8%;P<0.01).CONCLUSION As per our study results,TD/TJ approach appears to be associated with lower rate of adverse events and comparable efficacy when compared to the TG approach for the EUS-GBD.Additionally,use of cautery-enhanced LAMS for EUS-GBD is associated with a more favorable adverse event profile compared to cold LAMS.Though the approach chosen depends on several patient and physician factors,the above findings could help in deciding the ideal drainage route when both TG and TD/TJ approaches are feasible.