Tsuji Shujiro, Itoi Takao, Sofuni Atsushi, Mukai Shuntaro, Tonozuka Ryosuke, Moriyasu Fuminori
Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
J Hepatobiliary Pancreat Sci. 2015 Jun;22(6):E22-7. doi: 10.1002/jhbp.207. Epub 2015 Feb 16.
Endoscopic papillectomy (EP) has been recognized as a safe and reliable treatment for ampullary adenomas. In this article, we describe important tips and tricks in EP of ampullary tumors on the basis of our large case series outcome. Between May 1999 and April 2014, 115 patients underwent EP at Tokyo Medical University hospital. The mean tumor diameter was 16.2 (6-35) mm. The final pathological diagnoses were adenoma, cancer in adenoma, cancer, and hyperplasia in 85, 13, 10, and seven patients, respectively. "En bloc" or "piecemeal" EP was performed with a polypectomy snare forceps using "Endocut® mode". Prophylactic pancreatic duct stents were placed after EP. Consequently, a single treatment session was possible in 93 (80.9%) patients. Additional treatment was required in the remaining 22 (19.1%) patients. For these 22 patients, the postresection pathological diagnoses were adenoma in 15 patients and cancer in seven patients. Two patients with cancer and venous permeation required surgical operation. The final complete resection rate was 98.2%. Several complications observed included pancreatitis (10.4%), bleeding (18.2%), perforation (2.6%), cholangitis (1.7%), and papillary stenosis (4.3%). One patient died of procedure-related complications. In conclusion, endoscopic papillectomy showed a high technical success rate. However, possible complications and occasional fatal complications should be considered when using EP.
内镜下乳头切除术（EP）已被公认为是治疗壶腹腺瘤的一种安全可靠的方法。在本文中，我们根据我们大量病例系列的结果，描述了壶腹肿瘤内镜下乳头切除术的重要技巧。1999年5月至2014年4月期间，115例患者在东京医科大学医院接受了内镜下乳头切除术。肿瘤平均直径为16.2（6 - 35）mm。最终病理诊断分别为腺瘤、腺瘤内癌、癌和增生的患者有85例、13例、10例和7例。使用“Endocut®模式”的息肉切除圈套器进行“整块”或“分片”内镜下乳头切除术。内镜下乳头切除术后放置预防性胰管支架。因此，93例（80.9%）患者仅需一次治疗。其余22例（19.1%）患者需要额外治疗。对于这22例患者，切除术后病理诊断为腺瘤的有15例，癌的有7例。2例伴有静脉浸润的癌患者需要手术治疗。最终完全切除率为98.2%。观察到的几种并发症包括胰腺炎（10.4%）、出血（18.2%）、穿孔（2.6%）、胆管炎（1.7%）和乳头狭窄（4.3%）。1例患者死于与手术相关的并发症。总之，内镜下乳头切除术显示出较高的技术成功率。然而，使用内镜下乳头切除术时应考虑到可能的并发症和偶尔的致命并发症。
