Khirurgiia · 2025
[Endoscopic treatment of patients with adenomas of the major duodenal papilla and familial adenomatous polyposis].
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Starkov Yu G, Vagapov A I, Zamolodchikov R D, Dzhantukhanova S V
Аннотация
OBJECTIVE: To demonstrate the effectiveness and safety of intraluminal endoscopic treatment of patients with adenomas of the major duodenal papilla and familial adenomatous polyposis.
MATERIAL AND METHODS: Over the past 4 years, 13 patients with adenomas of the major duodenal papilla and familial adenomatous polyposis underwent surgery in our hospital. Of these, 7 patients had exclusively extrapapillary adenomas without signs of spread to the ducts. Four patients had a mixed type of adenoma (type IV), i.e. a combination of extrapapillary component with intraductal one. In 2 cases, neoplasms had exclusively intraductal growth (type III). In 6 cases, adenoma spread to the common bile duct, in 3 cases - to the walls of the pancreatic duct.
RESULTS: Technical success was achieved in all cases. Postoperative complications occurred in 3 cases: moderate acute post-manipulation pancreatitis in 2 patients and delayed bleeding in 1 patient. Control examination revealed residual fragments of adenomatous tissue in 2 cases that required repeated endoscopic resection of residual tissues of the major duodenal papilla.
CONCLUSION: Standardized criteria for choosing the optimal surgery for adenomas of the major duodenal papilla depending on characteristics of tumor growth, as well as its topographic and anatomical features made it possible to personalize optimal endoscopic removal of adenomas of the major duodenal papilla with minimal risk of postoperative complications.
MATERIAL AND METHODS: Over the past 4 years, 13 patients with adenomas of the major duodenal papilla and familial adenomatous polyposis underwent surgery in our hospital. Of these, 7 patients had exclusively extrapapillary adenomas without signs of spread to the ducts. Four patients had a mixed type of adenoma (type IV), i.e. a combination of extrapapillary component with intraductal one. In 2 cases, neoplasms had exclusively intraductal growth (type III). In 6 cases, adenoma spread to the common bile duct, in 3 cases - to the walls of the pancreatic duct.
RESULTS: Technical success was achieved in all cases. Postoperative complications occurred in 3 cases: moderate acute post-manipulation pancreatitis in 2 patients and delayed bleeding in 1 patient. Control examination revealed residual fragments of adenomatous tissue in 2 cases that required repeated endoscopic resection of residual tissues of the major duodenal papilla.
CONCLUSION: Standardized criteria for choosing the optimal surgery for adenomas of the major duodenal papilla depending on characteristics of tumor growth, as well as its topographic and anatomical features made it possible to personalize optimal endoscopic removal of adenomas of the major duodenal papilla with minimal risk of postoperative complications.