Evaluation of different methods of endoscopic papillectomy for adenomas of the major duodenal papilla

Abstract

Objective – to assess the outcomes of endoscopic papillectomy (EP) using standard techniques, as well as to develop and implement novel surgical intervention approaches.

Materials and methods. Between 2021 and 2024, the Department of Interventional Endoscopy at the National Cancer Institute performed EP for adenoma of the major duodenal papilla (MDP) on 19 patients, 10 women (52.63%) and 9 men (47.37%), aged 24 to 78 years, with a mean age of 45.6 years. We observed clinical signs of biliary obstruction and cholangitis in the majority of cases (2 (63.15%)).

Results. 10 patients (52.63%) with tumours <1.0 cm underwent the standard procedure of en‑bloc loop resection (Group 1). To prevent intraoperative and postoperative complications, we developed and implemented a two‑stage EP procedure in 6 (31.57%) cases (Group 2). In 3 (15.78%) patients with tumours ranging from 5.0 to 8.0 cm, the piecemeal approach was used to remove all fragments from the area of the neoplasm that reached into the intestinal lumen (Group 3). After a three‑month follow‑up, 2 patients (10.5%) from Group 3 had a recurrence of an adenoma of the MDP. Both cases required loop diathermy excision for recurrent neoplasms and stent removal. Routine tests at 3 and 6 months revealed no evidence of disease progression.

Conclusions. The topographic and anatomical characteristics of the MDP area determine the complexity of surgical interventions for patients with neoplasms. The novel EP approach minimizes the risks associated with both early and late postoperative complications. The outcomes achieved by employing EP in the treatment of patients with MDP adenomas support its recommendation as the primary approach at specialized centers.