Endoscopic management of adenoma of the major duodenal papilla
Endoscopic management of adenoma of the major duodenal papilla
复制标题
DOI：
10.1016/s0016-5107(03)02366-6
复制
发表时间：
2004-02-01
影响因子：
7.7
通讯作者：
Howell, DA
中科院分区：
文献类型：
--
作者：
Catalano, MF;Linder, JD;Howell, DA
背景：众所周知，十二指肠乳头腺瘤有恶变的可能。标准治疗是外科手术（十二指肠切开术/局部切除术、胰管切除术）。内窥镜管理的描述，但没有建立共识的方法乳头切除术或需要监测。本研究介绍了内镜下管理和长期随访乳头状肿瘤的4组专家pancreaticobiliary endoscopist.Methods：concentive乳头状肿瘤患者提到4 pancreaticobiliary内镜中心进行评价内镜乳头状切除术进行了审查。对于每例患者，完成了广泛的问卷调查，其中包括19个术前和15个术后数据点。共纳入了103例尝试进行内镜切除术的患者（53例女性，50例男性，年龄范围24-93岁）。其中，72例为散发性腺瘤，其余患者为家族性腺瘤性息肉病，包括加德纳变异型。主要症状为黄疸/胆管炎/疼痛（n = 59）、胰腺炎（n = 18）和出血（n = 12）。结果：内镜治疗成功，长期，83例（80%）和失败（初始失败或复发肿瘤）20例（20%）。成功率与年龄较大（54.7 [16.6] vs. 46.6 [21.7]岁; p = 0.08）和病变较小（21.1 [8.3] vs. 29.7 [7.2] mm; p
Background: It is well established that adenoma of the major duodenal papilla has a potential for malignant transformation. Standard treatment has been surgical (duodenotomy/local resection, pancreaticoduodenectomy). Endoscopic management is described, but there is no established consensus regarding the approach to papillectomy or the need for surveillance. This study describes endoscopic management and long-term follow-up of papillary tumors by 4 groups of expert pancreaticobiliary endoscopists.Methods: Consecutive patients with papillary tumors referred to 4 pancreaticobiliary endoscopy centers for evaluation for endoscopic papillectomy were reviewed. For each patient, an extensive questionnaire was completed, which included 19 preoperative and 15 postoperative data points. A total of 103 patients (53 women, 50 men, age range 24-93) who underwent attempted endoscopic resection were included. Of these, 72 had sporadic adenoma, and the remaining patients had familial adenomatous polyposis, including Gardner's variant. Presenting symptoms were jaundice/cholangitis/pain (n = 59), pancreatitis (n = 18), and bleeding (n = 12). Twenty-six patients were asymptomatic.Results: Endoscopic treatment was successful, long term, in 83 patients (80%) and failed (initial failure or recurrent tumor) in 20 (20%) patients. Success was significantly associated with older age (54.7 [16.6] vs. 46.6 [21.7] years; p = 0.08) and smaller lesions (21.1 [8.3] vs. 29.7 [7.2] mm; p