title: Clinical impact of endoscopic papillectomy for benign-malignant borderline lesions of the major duodenal papilla.
abstract: OBJECTIVE
  The present study retrospectively analyzed the clinical impact of endoscopic papillectomy on the selection of a treatment strategy for patients with benign-malignant borderline lesions of the major duodenal papilla.
  
  
  METHODS
  Between November 1995 and July 2009, 28 patients were selected for endoscopic papillectomy. The clinical impact of endoscopic papillectomy was assessed. Snare resection was performed in a radical fashion.
  
  
  RESULTS
  An endoscopic papillectomy was technically feasible in all patients. En bloc excision was achieved in 22 cases (79%). The final histopathological diagnoses of the endoscopic specimen were 17 adenoma (61%), 7 carcinoma in adenoma (25%), and 4 adenocarcinoma (14%). Two out of the four adenocarcinoma cases were referred for surgery. The other two patients with negative margins have not experienced recurrences during the follow-up period. A residual tumor was detected in 1 out of 17 cases (6%) of adenoma and 2 out of 7 cases (29%) of carcinoma in adenoma.
  
  
  CONCLUSIONS
  Endoscopic papillectomy is therefore considered to be an effective treatment for patients with a benign-malignant borderline lesion of the major duodenal papilla. This method also has an important clinical impact because it provides an accurate diagnosis, aids in the selection of an appropriate treatment strategy, and reduces unnecessary surgery.
authors.affiliation: Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan.
authors.forename: Megumi
authors.initials: M
authors.lastname: Harano
authors.forename: Shomei
authors.initials: S
authors.lastname: Ryozawa
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Iwano
authors.forename: Kumiko
authors.initials: K
authors.lastname: Taba
authors.forename: Manabu
authors.initials: M
authors.lastname: Sen-Yo
authors.forename: Isao
authors.initials: I
authors.lastname: Sakaida
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D014670:Ampulla of Vater / Q000473:pathology / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D003937:Diagnosis, Differential; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome