title: Endoscopic papillectomy, single-centre experience.
abstract: BACKGROUND
  Endoscopic removal of benign tumours of papilla is increasing. Our aim was to evaluate the outcome of endoscopic resection of papillary tumours.
  
  
  METHODS
  In the years 2000-2012, 61 papillectomies were performed in Helsinki University Central Hospital. The cases were analysed retrospectively.
  
  
  RESULTS
  There were 35 patients with benign tumour of papilla without familial adenomatous polyposis (FAP), 16 patients with FAP and 10 patients with ampullary cancer. Jaundice and bile duct dilation were risk factors for malignancy (p < 0.001). In benign tumours, the recurrence rate was 25.5 %. In 5/51 benign tumour cases (9.8 %), a pancreaticoduodenectomy was performed. The remaining cases were treated endoscopically. Neither tumour size, resection in one piece or piecemeal technique, nor coagulation of resection margins had an effect on the development of residual tumour. The total complication rate was 24.6 %. Pancreatitis developed in six patients (9.8 %, 3 mild and 3 moderate). In benign tumour cases, pancreatic stent decreased pancreatitis rate (p = 0.045). In cases where only a pancreatic sphincterotomy was performed, the risk of pancreatitis was high 4/7 (57 %). Bleeding was the most common complication (18 %). Only one patient was operated due to complication, a post-papillectomy bleeding. In six out of seven non-operated cancer patients, the disease progressed.
  
  
  CONCLUSIONS
  Endoscopic papillectomy is an effective procedure for treating benign papillary tumours. Jaundice and bile duct dilation are more common in malignant tumours. Pancreatic stent decreases the risk of post-papillectomy pancreatitis. Pancreatic sphincterotomy without stenting carries a high risk of pancreatitis. For papillary cancer, surgery is recommended.
authors.affiliation: Department of Gastrointestinal and General Surgery, Helsinki University Central Hospital, P.O. Box 340, 00029 HUS, Helsinki, Finland.
authors.forename: Shamel
authors.initials: S
authors.lastname: Ismail
authors.forename: Udd
authors.initials: U
authors.lastname: Marianne
authors.forename: Järvinen
authors.initials: J
authors.lastname: Heikki
authors.forename: Halttunen
authors.initials: H
authors.lastname: Jorma
authors.forename: Kylänpää
authors.initials: K
authors.lastname: Leena
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D003137:Common Bile Duct Diseases / Q000175:diagnosis / Q000601:surgery; D003138:Common Bile Duct Neoplasms / Q000175:diagnosis / Q000601:surgery*; D004384:Duodenoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome