Endoscopic therapy of benign tumors of the papilla of Vater

Abstract

Background and study aims: The aim of this study was to evaluate the technical feasibility and safety of endoscopic treatment in 16 patients with benign adenomas of the papilla of Vater.

Patients and methods: This study involved 16 patients with confirmed adenoma of the papilla of Vater. Diagnosis of adenoma was made by endoscopic findings, benign histologic findings at forceps and snare biopsy, and endoscopic ultrasonography (EUS). The size of the tumor ranged from 2 to 7 cm. Papillectomy by diathermy snare consisted of excision of the adenoma together with the papilla of Vater. In three patients, residual tissue that could not be removed with the snare was removed using argon coagulation.

Results: Postpapillectomy complications included bleeding in two patients. Two patients had acute pancreatitis. No procedure-related death occurred. Follow-up duodenoscopy was performed at 6 and 12 months after papillectomy and yearly thereafter. Three patients had recurrences (benign adenoma in all cases). Two patients were treated endoscopically. One patient with extension of tumor into the distal common bile duct was referred to surgery.

Conclusions: Endoscopic resection of adenomas of the papilla of Vater appears to be a viable alternative to surgical therapy, particularly in patients for whom surgery is a high-risk approach.