Early Diagnosis And Endoscopic Treatmennt Of The Ampullary Neoplasm

[Background and aim] Pancreaticoduodenectomy is considered to be the standardtreatment for ampullary cancer, Endoscopic papillectomy (EP) has been utilized in cases ofampullary adenoma since the early1980s.This paper aim to evaluate the value ofdiagnosing the ampullary neoplasm and the endoscopic papillectomy (EP) for ampullaryadenoma(AA)．[Methods] We conducted a review of studies regarding endoscopic diagnosis early andand treatment and accurate pretreatment staging for ampullary neoplasms. The resectionrate，complication rate，local residual rate and local recurrence of EP for AA were alsoreviewed．[Results] From July2006to July2011,49patients were confirmed ampullary neoplasmwith endoscopically diagnosed and pathologically.in which21cases were ampullarycancer and27cases were ampullary adenoma.This27cases of ampullary adenoma, inwhich7cases were only adenoma and10cases were adenoma accompany LIEN and6caseswere adenoma accompany HIEN and4cases adenoma accompany local cancer.preoperative examination such as type-B ultrasonic of belly、 CT、 MRCP、EUS、endoscopy and biopsy etc.can evaluate lymphatic permeation、vascular invasion、lymphnode metastasis、ductal infiltration into the pancreatic/bile duct and choose those patientswho fit for EP. Twenty cases were choosed.IDUS and ERCP were carried out before EP.The total resection rate was95%（19/20），the success rate after the first resection was75%（15/20）；ductal infiltration into the bile duct was found in2case，the operation was ended1case(5%). All patients（19cases）were followed up at a mean period of24months(range8-72months)．Twe cases（10%） was found local residual after the first EP and thenremoved successfully.Twe cases（10%）was found local recurrence and then also removed successfully. Four cases six times（20%）appear complications.Short—termcomplications(﹤24h) after EP included one case of perforation who was recovery afternonsurgical treatment，1case（5%） of bleeding who was recovery after nonsurgicaltreatment such as medical hemostasis、APC、hemoclipping etc,2cases of mild acutepancreatitis and2cases of acute cholangitis. Long-term complications（﹥24h） after EPincluded one case of bile duck stone after stent placement four months．Noprocedure-related death was observed．All complications were dealed without surgicaltreatment and no procedure-related death was observed.[Conclusion] Duodenal pepilla anatomy was particular,the neoplasm will infiltrate theintenal organs around.surgical operation is complexity and huge wound. So diagnosis theampullary neoplasm early and even endoscopic treatment exist clinical value.With thedeveloping of endoscopic technology, EP is gragually turnning into a safe and effectivemodality for ampullary adenoma．...