Endoscopic papillectomy into the treatment of neoplastic lesions of vater papilla.
Adenomas of the duodenal papilla are rare. The frequency of malignant adenomas is 15-30%. Villous adenoma is a premalignant lesion with the highest rate of transformation. Options for surgical treatment include endoscopic and ablation resection, transduodenal ampullectomy, duodeno-pancreatectomy.


OBJECTIVE
Evaluation of the efficacy and safety of endoscopic papillectomy for ampullary adenomas.


METHODS
12 patients were selected (F:M, 5:7, age range 37 - 68 years) with ampullary adenoma, treated by endoscopic papillectomy. Biliary sphincterotomy was performed in 6 cases; and pancreatic sphincterotomy was performed in 3 cases. Biliary stenting was performed in 2 cases; pancreatic stent was placed in 11 cases.


RESULTS
En bloc resection was performed in 8 cases, and piecemeal resection in 4 cases. Complete resection R0 was noted in 10 cases. Pathology examination has show: tubulo-villous adenoma (5 patients); villous adenoma (4 patients), tubular adenoma (2 cases), adenocarcinoma (one case). Complications were immediate: bleeding (2 cases) and pancreatitis (1 case). Follow-up endoscopy reveals no ductal stenosis or recurrence.


CONCLUSIONS
Endoscopic papillectomy is a safe and well-tolerated alternative to surgical treatment of ampullary adenoma.
Department of Surgery "N. Anestiadi", Hepato- Bilio-Pancreatic Surgery Laboratory, University of Medicine and Pharmacy "N. Testemitsanu", Chişinău, Moldova.
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G
Ghidirim
Department of Surgery "N. Anestiadi", Hepato- Bilio-Pancreatic Surgery Laboratory, University of Medicine and Pharmacy "N. Testemitsanu", Chişinău, Moldova.
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I
Mişin
Department of Surgery "N. Anestiadi", Hepato- Bilio-Pancreatic Surgery Laboratory, University of Medicine and Pharmacy "N. Testemitsanu", Chişinău, Moldova.
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V
Istrate
Internal Medicine. Gastroenterology. Hepatology Department, University of Medicine and Pharmacy of Craiova, Gastroenterology Department - Emergency Hospital Craiova.
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S
Cazacu
Vater papilla; ampullary adenoma; bleeding; endoscopic papillectomy; pancreatitis; sphyncterotomy