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World Journal of Gastroenterology 2009年第28期15卷 3486-3492页

作者： Stacy B Menees Philip Schoenfeld Hyungjin Myra Kim Grace H Elta Eastern Virginia Medical School Norfolk Virginia 23502 United States Division of Gastroenterology University of Michigan Ann Arbor MI 48109 United States VA Health Services & Research Department Ann Arbor MI Center for Statistical Consultation and Research University of Michigan Ann Arbor MI 48109United States

AIM： To investigate the endoscopic ampullectomy practices of expert biliary endoscopists. METHODS： An anonymous expert biliary endoscopists practices. survey was mailed to 79 to assess ampullectomy RESULTS： Forty six （58%） biliary endoscopists returned the questionnaire. Of these, 63% were in academia and in practice for an average of 16.4 years （± 8.6）. Endoscopists performed an average of 1.1 （± 0.8） ampullectomies per month. Prior to ampullectomy, endoscopic ultrasound was ＂always＂ utilized by 67% of respondents vs ＂sometimes＂ in 31% of respondents. Empiric biliary sphincterotomy was not utilized uniformly, only 26% ＂always＂ and 37% ＂sometimes＂ performed it prior to resection. Fifty three percent reported ＂never＂ performing empiric pancreatic sphincterotomy prior to ampullectomy. Practitioners with high endoscopic retrograde cholangiopancreatography volumes were the most likely to perform a pancreatic sphincterotomy （OR = 10.9; P = 0.09）. Participants overwhelmingly favored ＂always＂ placing a prophylactic pancreatic stent, with 86% placing it after ampullectomy rather than prior to resection （23%）. Argon plasma coagulation was the favored adjunct modality （83%） for removal of residual adenomatous tissue. Practitioners uniformly （100%） preferred follow-up examination to be within 6 mo ***： Among biliary experts, there is less variation in ampultectomy practices than is reflected in the literature.

关键词： Endoscopic retrograde cholangiopancreaography ampullectomy Papillectomy Ampulla ofVater, Common bile duct neoplasms Adenoma

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Surgical method choice and coincidence rate of pathological diagnoses in transduodenal ampullectomy: A retrospective case series study and review of the literature

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World Journal of Clinical Cases 2019年第6期7卷 717-726页

作者： Feng Liu Jia-Lin Cheng Jing Cui Zong-Zhen Xu Zhen Fu Ju Liu Hu Tian Department of General Surgery Shandong Provincial Qianfoshan HospitalShandong University Taishan Medical University Department of Pathology Shandong Provincial Qianfoshan HospitalShandong University Medical Research Center Shandong Provincial Qianfoshan HospitalShandong University

BACKGROUND Transduodenal ampullectomy(TDA) is not in wide clinical use due to its low radical effect and a high recurrence rate of tumors. However,TDA is still an effective treatment method; it has great clinical value in cases of duodenal benign tumors,precancerous lesions,and benign and malignant borderline tumors,and can avoid the risks associated with pancreaticoduodenectomy with larger resection range and greater thoroughness than endoscopic *** To investigate the surgical method choice and the coincidence rate of pathological diagnoses in TDA for ampullary *** Ten patients with ampullary neoplasms underwent TDA based on the fact that their endoscopic biopsy results suggested benign lesions,and the endoscopic ultrasound(EUS)-assessed tumors were resectable. All cases underwent duodenal ampullary lesion endoscopic biopsy,intraoperative frozen-section pathological examination,and postoperative pathological *** study included seven patients with benign tumors and three with malignant tumors(1 pTis,2 pT1),according to the postoperative pathology results. The coincidence rate of the postoperative pathology results with the intraoperative frozen-section biopsy results was 100%(10/10),and the coincidence rate with the endoscopic biopsy results was 70%(7/10) based on pathological *** endoscopic biopsy false-negative rate was 30%(3/10). All patients were followed for 6 to 70 mo without tumor recurrence or *** The coincidence rate of postoperative pathology results,intraoperative frozensection pathology results,and endoscopic biopsy results is the restraining factor of TDA clinical application. Endoscopic biopsy results and EUS have importance relevance to surgical planning. Intraoperative frozen-section pathology results have a significant influence on the choice of surgical procedure.

关键词： Ampulla of Vater Ampullary neoplasm Transduodenal ampullectomy Pathological diagnoses

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Management of ampullary neoplasms: A tailored approach between endoscopy and surgery

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World Journal of Gastroenterology 2015年第26期21卷 7970-7987页

作者： Francesca Panzeri Stefano Crippa Paola Castelli Francesca Aleotti Alessandro Pucci Stefano Partelli Giuseppe Zamboni Massimo Falconi Department of Surgery Ospedale "Mater Salutis" Division of Pancreatic Surgery San Raffaele Hospital IRCCSVita e Salute University Department of Pathology Ospedale Sacro Cuore-Don Calabria

Ampullary neoplasms,although rare,present distinctive clinical and pathological features from other neoplastic lesions of the periampullary *** specific guidelines about their management are available,and they are often assimilated either to biliary tract or to pancreatic *** to their location,they tend to become symptomatic at an earlier stage compared to pancreatic *** behaviour results in a higher resectability rate at *** a pathological point of view they arise in a zone of transition between two different epithelia,and,according to their origin,may be divided into pancreatobiliary or intestinal *** classification has a substantial impact on *** most cases,pancreaticoduodenectomy represents the treatment of choice when there is an overt or highly suspicious malignant *** rate of potentially curative resection is as high as 90% and in high-volume centres an acceptable rate of complications is *** selected situations less invasive approaches,such as ampullectomy,have been advocated,although there are some concerns mainly because of a higher recurrence rate associated with limited resections for invasive ***,these methods have the drawback of not including an appropriate lymphadenectomy,while nodal involvement has been shown to be frequently present also in apparently lowrisk *** ampullectomy is now the procedure of choice in case of low up to high-grade dysplasia providing a proper assessment of the T status by endoscopic *** the present paper the evidence currently available is reviewed,with the aim of offering an updated framework for diagnosis and management of this specific type of disease.

关键词： Ampulla of Vater Cancer of the ampullaof Vater Pancreaticoduodenectomy ampullectomy Prognosis Ampullary neoplasm Lymphadenectomy Recurrence

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Endoscopic resection of an ampullary carcinoid presenting with upper gastrointestinal bleeding:A case report and review of the literature

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World Journal of Gastroenterology 2007年第8期13卷 1268-1270页

作者： Nooman Gilani Francisco C Ramirez Carl. T. Hayden Veterans Administration Medical Center Phoenix AZ United States

Ampullary carcinoid is a rare tumor that can present with gastrointestinal bleeding, obstructive jaundice or pancreatitis. Some of these tumors are associated with Von Recklinghausen disease. The usual surgical options are a biliary-enteric anastomosis, Whipple procedure or rarely a local resection. The mean survival dqes not appear to be much different after a pancreaticoduodenectomy versus local surgical excision. We report a very rare case of a non-metastatic ampullary carcinoid causing upper gastrointestinal bleeding, which was managed by endoscopic ampullectomy.

关键词： Carcinoid Ampulla of Vater Ampullary tumor ampullectomy Gastrointestinal bleeding

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Diagnosis and management of ampullary adenoma:The expanding role of endoscopy

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World Journal of Gastrointestinal Endoscopy 2011年第12期3卷 241-247页

作者： Payam Chini Peter V Draganov Division of Gastroenterology Hepatology and NutritionUniversity of FloridaGainesvilleFL 32610United States

Ampullary adenoma is a pre-cancerous lesion arising from the duodenal papilla that is often *** is important to distinguish whether the adenoma is sporadic or arises in the setting of familial adenomatous polyposis as this has important implications with respect to management and *** modalities are available for staging of these lesions to help guide the most appropriate *** that are used most commonly include computed tomography,endoscopic ultrasound,and endoscopic retrograde *** recent years,endoscopy has become the primary modality for therapeutic management of the majority of ampullary *** remains the standard curative procedure for confirmed or suspected *** review will provide the framework for the diagnosis and management of ampullary adenomas from the perspective of the practicing gastroenterologist.

关键词： Ampullary adenoma ampullectomy Duodenal papilla Familial adenomatous polyposis Papillectomy

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Feasibility and safety of endoscopic cryoablation at the duodenal papilla: Porcine model

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World Journal of Gastrointestinal Endoscopy 2015年第7期7卷 728-735页

作者： Dennis Yang Mary K Reinhard Mihir S Wagh Division of Gastroenterology University of Florida Animal Care Services Infectious Disease and Pathology University of Florida

AIM: To assess the feasibility and safety of liquid nitrogen spray cryoablation at the duodenal papilla in a porcine model. METHODS: This prospective study protocol was approved by the University of Florida Institutional Animal Care and Use Committee. Six pigs underwent liquid nitrogen spray cryotherapy at the duodenal papilla. Freeze time of 20-s was applied per cycle(4 cycles/session). Survival animals(n = 4) were monitored for adverse events. Hemoglobin, white blood count, liver tests, and lipase were obtained at baseline and post-treatment. EGD was performed on day#7 to evaluate the papilla and for histology. All animals were euthanized and necropsy was performed at the end of the one-week survival period. Feasibility was defined as successful placement of the decompression tube in the duodenum, followed by delivery of spray cryotherapy to the duodenal papilla. Safety was determined by monitoring post-treatment blood tests and clinical course. Treatment effect was defined as endoscopic and histologic changes after cryotherapy. This was established by comparing endoscopic and histologic findings from mucosal biopsies prior to cryotherapy and on post-operative day(POD)#7. Full-thickness specimen was obtained post-mortem to assess depth of injury. RESULTS: Spray cryotherapy was feasible and successfully performed in all 6/6(100%) animals. Cryospray with liquid nitrogen(four 20-s freeze-thaw cycles) at the duodenal papilla resulted in white frost formation at and around the target region. The mean proceduraltime was 54.5 min(range 50-58 min). All six animals studied had stable blood pressure, heart rate, and pulse oximetry measurements during the procedure. There were no significant intra-procedural adverse events. There were no significant differences in hemoglobin, white cell count, liver tests or lipase from baseline to post-cryotherapy. Survival animals were monitored daily post-operatively without any clinical ill effects from the cryotherapy. There was no blee

关键词： Liquid-nitrogen cryotherapy Cryoablation Duodenal adenoma ampullectomy Papillectomy

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Endoscopic management of adenomatous ampullary lesions

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World Journal of Methodology 2015年第3期5卷 127-135页

作者： Jesús Espinel Eugenia Pinedo Vanesa Ojeda Maria Guerra del Rio Department of Digestive Diseases Hospital Universitario de León Department of Radiodiagnosis Hospital Universitario de León Department of Digestive Diseases Hospital Universitario Dr. Negrín Consultant Gastroenterologist Burton Hospitals NHS foundation trust

Lesions of the ampulla of Vater represent an uncommon group of gastrointestinal malignancies. The majority of lesions of the ampulla of Vater are either adenomas or adenocarcinomas. Ampullary lesions are often incidental findings. Accurate preoperative diagnosis and staging of ampullary tumors is imperative for predicting prognosis and determining the most appropriate therapeutic approach. Endoscopic ampullectomy is a safe and efficacious therapeutic procedure that can obviate the need for potentially major surgical intervention. This review will provide the framework for the diagnosis and management of ampullary lesions from the perspective of the practicing gastroenterologist. Strategies for safe and successful endoscopic ampullectomy with a focus on accurate preoperative diagnosis and staging, resection technique, and management of complications are presented.

关键词： Papillary tumors Endoscopic ampullectomy Endoscopic ultrasound Ampullary adenoma Pancreatitis

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