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World J Gastrointest Endosc. Aug 10, 2015; 7(10): 987-994
Published online Aug 10, 2015. doi: 10.4253/wjge.v7.i10.987
Endoscopic papillectomy: The limits of the indication, technique and results
José Celso Ardengh, Rafael Kemp, Éder Rios Lima-Filho, José Sebastião dos Santos
José Celso Ardengh, Rafael Kemp, José Sebastião dos Santos, Division of Digestive and Endoscopic Surgery, Department of Surgery and Anatomy, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto 14049-900, São Paulo, Brazil
Éder Rios Lima-Filho, Department of Surgery, Hospital Federal dos Servidores do Estado, Rua Sacadura Cabral, Rio de Janeiro 20221-903, Brazil
Author contributions: Ardengh JC, Kemp R, Lima-Filho ÉR and Santos JS contributed to this paper.
Conflict-of-interest statement: No.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: José Sebastião dos Santos, MD, PhD, Professor, Division of Digestive and Endoscopic Surgery, Department of Surgery and Anatomy, Ribeirão Preto School of Medicine, University of São Paulo, Av. Bandeirantes, 3900 - 9º andar do Hospital das Clínicas de Ribeirão Preto, Ribeirão Preto 14049-900, Brazil. jsdsanto@fmrp.usp.br
Telephone: +55-16-36022508 Fax: +55-16-36330836
Received: October 29, 2014
Peer-review started: October 29, 2014
First decision: November 27, 2014
Revised: June 9, 2015
Accepted: July 16, 2015
Article in press: July 17, 2015
Published online: August 10, 2015
Processing time: 292 Days and 10.7 Hours
Abstract

In the majority of cases, duodenal papillary tumors are adenomas or adenocarcinomas, but the endoscopy biopsy shows low accuracy to make the correct differentiation. Endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography are important tools for the diagnosis, staging and management of ampullary lesions. Although the endoscopic papillectomy (EP) represent higher risk endoscopic interventions, it has successfully replaced surgical treatment for benign or malignant papillary tumors. The authors review the epidemiology and discuss the current evidence for the use of endoscopic procedures for resection, the selection of the patient and the preventive maneuvers that can minimize the probability of persistent or recurrent lesions and to avoid complications after the procedure. The accurate staging of ampullary tumors is important for selecting patients to EP or surgical treatment. Compared to surgery, EP is associated with lower morbidity and mortality, and seems to be a preferable modality of treatment for small benign ampullary tumors with no intraductal extension. The EP procedure, when performed by an experienced endoscopist, leads to successful eradication in up to 85% of patients with ampullary adenomas. EP is a safe and effective therapy and should be established as the first-line therapy for ampullary adenomas.

Keywords: Epidemiology; Ampullary tumors; Endoscopic resection; Endoscopic ultrasound; Staging; Endoscopic papillectomy; Surgical ampullectomy

Core tip: Although the endoscopic papillectomy (EP) represent higher risk endoscopic interventions, it has successfully replaced surgical treatment for benign or malignant papillary tumors. The accurate staging of ampullary tumors is important for selecting patients to EP or surgical treatment. Compared to surgery, EP is associated with lower morbidity and mortality, and seems to be a preferable modality of treatment for small benign ampullary tumors with no intraductal extension. The EP procedure, when performed by an experienced endoscopist, leads to successful eradication in up to 85% of patients with ampullary adenomas. EP is a safe and effective therapy and should be established as the first-line therapy for ampullary adenomas.