title: Safety and outcome of endoscopic snare excision of the major duodenal papilla.
abstract: BACKGROUND
  The optimal management of adenoma of the major duodenal papilla is not established. Options include surgical excision, endoscopic ablative techniques, snare excision, and observation with periodic biopsies. The aims of this retrospective study were to determine the safety and outcome of snare excision of the papilla.
  
  
  METHODS
  Twenty-eight snare excisions of the papilla were performed in 26 patients. Sixteen had familial adenomatous polyposis. In 22 procedures, a minisnare was used, and in 6 cases a prototype snare was designed for excision of the papilla. Pancreatic stents were placed as a prophylactic measure at the discretion of the endoscopist (n = 10).
  
  
  RESULTS
  Histopathologically, resected tissue included 25 adenomas, 1 inflammatory polyp, 1 invasive malignancy, and 1 normal papilla. Immediate complications were minor bleeding (n = 2), mild pancreatitis (n = 4) and a duodenal perforation (n = 1). The presence (n = 10) or absence (n = 18) of a pancreatic stent did not correlate with subsequent pancreatitis (2 in each group, p = NS). Follow-up was available for 21 patients (median, 9 months; range, 2-32 months). Pancreatic duct stenosis at the papillectomy site resulted in pancreatitis in 2 patients (17%) at, respectively, 4 months and 24 months. Follow-up endoscopy revealed recurrent/residual adenomatous tissue in 2 (10%).
  
  
  CONCLUSIONS
  Snare excision of the major duodenal papilla was well tolerated. Most complications were mild except for a small duodenal perforation. Stenosis of the pancreatic duct orifice with pancreatitis may be a late complication.
authors.affiliation: Developmental Endoscopy Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55902, USA.
authors.forename: Ian D
authors.initials: ID
authors.lastname: Norton
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Gostout
authors.forename: Todd H
authors.initials: TH
authors.lastname: Baron
authors.forename: Alex
authors.initials: A
authors.lastname: Geller
authors.forename: Bret T
authors.initials: BT
authors.lastname: Petersen
authors.forename: Maurits J
authors.initials: MJ
authors.lastname: Wiersema
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000601:surgery*; D016145:Endoscopy, Digestive System / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome