Original articleClinical endoscopyGiant laterally spreading tumors of the papilla: endoscopic features, resection technique, and outcome (with videos)
Section snippets
Patient recruitment and lesion identification
Over a 24-month period ending in March 2009, patients referred for endoscopic treatment of papillary adenomas were enrolled prospectively. Giant papillary lesions with significant extrapapillary extension, identified as adenomatous tumors involving the major duodenal papilla, with a size greater than 30 mm, extending beyond the papilla onto the duodenal wall with the extrapapillary component equal to or greater than the size of the papillary lesion (and involving as much as two thirds of the
Results
During the study period, 25 patients with papillary adenomas were referred for consideration of endoscopic papillectomy. Ten patients had LST-P and 15 remaining patients had smaller conventional papillary lesions.
Discussion
The results of our series show that even in a mainly elderly population, the single-session combination of EMR and papillectomy is a viable option for LST-P. With careful tumor staging and meticulous resection technique, all LST-P were successfully removed in a single session. Our initial experience would also indicate that nearly all patients are cured with a single intervention.
For this study, we applied the Paris classification system of large sessile or flat neoplastic lesions of the
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2018, GastroenterologyCitation Excerpt :Lesions with low-grade and high-grade dysplasia with an intraductal tumor extension (ITE) of <10 mm are regarded as suitable for EP.5,9,10 Even if the lesion is largely spreading to the duodenal wall, between 40 and 60 mm in diameter, named laterally spreading tumors of the papilla (LST-P; Figure 5A), cure can be achieved by endoscopic treatment (EP combined with endoscopic mucosal resection [EMR]) at rates comparable with lesions confined to the papilla.11 If malignancy is expected, patients usually should be referred to surgery, even in early T1 cancers (tumor limited to Vater’s ampulla or sphincter of Oddi), owing to high rates of lymphovascular invasion (LVI; 56.7%) with coexisting LNM (18%).6,12
Ampullary Neoplasia
2018, ERCP, Third EditionManagement of duodenal polyps
2017, Best Practice and Research: Clinical GastroenterologyCitation Excerpt :Biliary stenting is generally not required, except in specific situations, such as prolonged procedural time, extensive piecemeal resections, and for patients at high risk of delayed bleeding. Biliary stenting may also reduce the risk of papillary stenosis, cholangitis and biliary obstruction from haemobilia in the event of bleeding [69,72]. Plastic stents are used if the bile duct is non-dilated.
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.