title: A novel approach emphasizing preoperative margin enhancement of tumor of the major duodenal papilla with narrow-band imaging in comparison to indigo carmine chromoendoscopy (with videos).
abstract: BACKGROUND
  Endoscopic papillectomy (EP) has been recognized as a safe and reliable treatment for tumor of the duodenal papilla. For complete resection, precise assessment of not only the intraductal extent but also the lateral margins of the tumor is mandatory before resection.
  
  
  OBJECTIVE
  Our purpose was to prospectively assess the enhancement of the lateral margins of tumor of the duodenal papilla for the treatment of EP by comparing narrow-band imaging (NBI) and indigo carmine (IC) chromoendoscopy.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  This procedure was performed in Tokyo Medical University Hospital.
  
  
  METHODS
  Fourteen consecutive cases of tumors of the major duodenal papilla.
  
  
  METHODS
  All patients underwent EP after evaluation by NBI and IC.
  
  
  METHODS
  Histologic evaluation of diagnosis of NBI and IC by comparison with en bloc tissue.
  
  
  RESULTS
  In all lesions, either IC or NBI were superior to conventional white-light imaging except in 1 IC case. The ability of NBI observation to emphasize the tumor margin was statistically significantly better than IC observation (P< .05). The en bloc EP was endoscopically successful in all cases, without fatal adverse events. En bloc tissue revealed 13 adenomas and 1 adenoma with focal adenocarcinoma. There was no residual adenoma in lateral margin specimens, either endoscopically or histologically.
  
  
  CONCLUSIONS
  The lesions resected were all relatively small. This was not a blinded randomized study.
  
  
  CONCLUSIONS
  This study demonstrated the feasibility and a certain degree of efficacy of NBI for enhancement of the tumor margin of duodenal papilla. Further blinded randomized studies involving large duodenal papillary tumors are required.
authors.affiliation: Department of Gastroenterology and Hepatology, Tokyo Medical University, National Cancer Institute, Shinjukuku, Tokyo, Japan. itoi@tokyo-med.ac.jp
authors.forename: Takao
authors.initials: T
authors.lastname: Itoi
authors.forename: Shujiro
authors.initials: S
authors.lastname: Tsuji
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sofuni
authors.forename: Fumihide
authors.initials: F
authors.lastname: Itokawa
authors.forename: Toshio
authors.initials: T
authors.lastname: Kurihara
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Tsuchiya
authors.forename: Kentaro
authors.initials: K
authors.lastname: Ishii
authors.forename: Nobuhito
authors.initials: N
authors.lastname: Ikeuchi
authors.forename: Masahiro
authors.initials: M
authors.lastname: Igarashi
authors.forename: Takuji
authors.initials: T
authors.lastname: Gotoda
authors.forename: Fuminori
authors.initials: F
authors.lastname: Moriyasu
mesh_terms: D000236:Adenoma / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000473:pathology* / Q000601:surgery; D001707:Biopsy, Needle; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D003952:Diagnostic Imaging / Q000379:methods*; D004379:Duodenal Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D004384:Duodenoscopy / Q000379:methods*; D019160:Endosonography / Q000379:methods; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007150:Immunohistochemistry; D007203:Indigo Carmine; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014741:Video Recording
chemical_list: D007203:Indigo Carmine