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Endoscopic treatment of a patient with duodenal major papilla adenoma and ansa pancreatica.

ABSTRACT: A 35-year-old female who suffered from recurrent pancreatitis was admitted to our hospital. Her magnetic resonance cholangiopancreatography revealed ansa pancreatica. And during endoscopic retrograde cholangiopancreatography, a major duodenal papilla adenoma was identified. Hybrid endoscopic mucosal resection of this lesion was performed with pancreatic stent placement through the minor papilla to prevent recurrent pancreatitis. To our knowledge, this is the first report of a major papilla adenoma associated with ansa pancreatica. These minimally invasive endoscopic treatments solved a difficult clinical problem and avoided traumatic surgery.

SUBMITTER: Wu YY

PROVIDER: S-EPMC10167413 | biostudies-literature | 2024 Apr

REPOSITORIES: biostudies-literature

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Endoscopic treatment of a patient with duodenal major papilla adenoma and ansa pancreatica.

Wu Yan-Yan YY Feng Yun-Lu YL Yang Ai-Ming AM

DEN open 20230508 1

A 35-year-old female who suffered from recurrent pancreatitis was admitted to our hospital. Her magnetic resonance cholangiopancreatography revealed ansa pancreatica. And during endoscopic retrograde cholangiopancreatography, a major duodenal papilla adenoma was identified. Hybrid endoscopic mucosal resection of this lesion was performed with pancreatic stent placement through the minor papilla to prevent recurrent pancreatitis. To our knowledge, this is the first report of a major papilla adeno ...[more]

PMID: 37180358

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Outcome of a novel modified endoscopic papillectomy for duodenal major papilla adenoma.

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| S-EPMC7572334 | biostudies-literature

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A case of carcinoma in an adenoma of the duodenal minor papilla successfully treated with endoscopic mucosal resection.

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| S-EPMC11579376 | biostudies-literature

Association between type of major duodenal papilla and difficult biliary cannulation at first endoscopic retrograde cholangiopancreatography in adults: a cross-sectional study with bootstrap method

Project description:Background The type of major duodenal papilla could be associated with difficult biliary cannulation at first endoscopic retrograde cholangiopancreatography (ERCP) in adults. Methods This retrospective cross-sectional study included patients undergoing ERCP for the first time by an expert endoscopist. We defined the type of papilla according to the endoscopic classification of Haraldsson in type 1-4. The outcome of interest was difficult biliary cannulation, defined according to the European Society of Gastroenterology. To assess the association of interest, we calculated crude and adjusted prevalence ratios (PRc and PRa, respectively) and their respective 95% confidence intervals (CI) using Poisson regression with robust variance models, employing bootstrap methods. For the adjusted model we included the variables age, sex, and indication for ERCP, according to an epidemiological approach. Results We included 230 patients. The most frequent type of papilla was type 1 (43.5%), and 101 (43.9%) of the patients presented difficult biliary cannulation. The results were consistent between the crude and adjusted analyses. After adjusting for age, sex, and ERCP indication, the prevalence of difficult biliary cannulation was highest in patients with papilla type 3 (PRa 3.66, 95%CI 2.49-5.84), followed by patients with papilla type 4 (PRa 3.21, 95%CI 1.82-5.75), and patients with papilla type 2 (PRa 1.95, 95%CI 1.15-3.20) compared to patients with papilla type 1. Conclusion In adults undergoing ERCP for the first time, patients with papilla type 3 had a greater prevalence of difficult biliary cannulation than patients with papilla type 1.

| S-EPMC9932863 | biostudies-literature

Duodenal major papilla morphology can affect biliary cannulation and complications during ERCP, an observational study.

Project description:BackgroundWe investigated whether duodenal major papilla morphology could be a risk factor for failure of selective biliary cannulation (SBC) and post endoscopic retrograde cholangiography and pancreatography (ERCP) complications.MethodsA prospectively recorded database was reviewed retrospectively. Patients were included if they received therapeutic ERCP and had naïve major duodenal papilla. We used Haraldsson's classification for papilla morphology, as follows: Regular (Type 1), Small (Type 2), Protruding or Pendulous (Type 3) and Creased or Ridged (Type 4). Risk factors for failing SBC and post-ERCP complications were analyzed by multivariate analysis.ResultsA total of 286 cases were included. Age, gender, indications and therapeutic procedures were not different among the four types of papillae. The failure rates of SBC with Type 3 papilla and Type 4 papilla were 11.11% and 6.25%, respectively. In the multivariate analysis, Type 2 papilla (odd ratio 7.18, p = 0.045) and Type 3 papilla (odd ratio 7.44, p = 0.016) were associated with greater SBC failure compared with Type 1 papilla. Malignant obstruction compared to stone (odds ratio 4.45, p = 0.014) and age (odd ratio = 1.06, p = 0.010) were also risk factors for cannulation failure. Type 2 papilla was correlated with a higher rate of post-ERCP pancreatitis (20%, p = 0.020) compared to the other types of papilla However, papilla morphology was not a significant risk factor for any complications in the multivariate analysis.ConclusionSmall papilla and protruding or pendulous papilla are more difficult to cannulate compared to regular papilla. Small papilla is associated with a higher rate of post-ERCP pancreatitis.

| S-EPMC7520951 | biostudies-literature

A simple endoscopic scoring system to differentiate between duodenal adenoma and carcinoma.

Project description: Diagnosis of nonampullary duodenal low grade adenoma (Vienna classification category 3, VCL 3) and high grade adenoma/carcinoma (VCL 4 or higher) is important for clinical management decisions. However, there are no criteria based on which endoscopic diagnosis can differentiate between VCL3 and VCL4 or higher. This study aimed to establish simple diagnostic criteria to differentiate between VCL3 and VCL4 or higher. This retrospective study included patients with superficial nonampullary duodenal epithelial tumors (NADETs) who underwent tumor resection between June 2004 and November 2016 at a single cancer center hospital. Using patient demographics and endoscopic findings from 2004 to 2013, variables related to the final histology of VCL4 or higher were analyzed, and a predictive model was developed. Validation analysis was performed on patients treated between 2014 and 2016. A total of 150 lesions in 134 patients were included. Lesion diameter, reddish color, depression, heterogeneous or no nodularity, and mixed or depressed macroscopic types were significantly predictive of VCL4 or higher. A predictive score model was developed and a score of 3 points was defined as an appropriate cutoff for predicting VCL4 or higher. In the validation analysis, the accuracy rate of VCL4 or higher diagnosis was 86 % when the score was ≥ 3 points. Scores between patients with VCL3 and VCL4 or higher were significantly different ( P = 0.0004). A simple and useful endoscopic scoring system was developed to preoperatively differentiate between VCL3 and VCL4 or higher among superficial NADETs.

| S-EPMC5546900 | biostudies-other

Case Report: Duodenal gastrointestinal stromal tumor misdiagnosed as tumor located on the major duodenal papilla leading to fatal gastrointestinal bleeding in a child

Project description: Not available

| S-EPMC11925956 | biostudies-literature

Efficacy of gel immersion endoscopic ultrasonography for delineating the duodenal papilla and pancreatobiliary ducts: A retrospective study with video.

Project description:ObjectivesEndoscopic ultrasonography is an important examination for periampullary diseases. The duodenum is filled with water to ensure a clear image and distend the duodenal wall without burying the papilla within duodenal folds; however, peristalsis frequently makes it difficult to maintain water within the duodenum. The gel immersion method (intestine is filled with viscosity gel) has recently been attracting attention. We evaluated the usefulness of using this method for endoscopic ultrasonography to detect and delineate the major duodenal papilla.MethodsFifty-nine consecutive patients who underwent gel immersion-endoscopic ultrasonography between February and March 2021 were included retrospectively. The papilla was observed by filling the duodenum with clear viscosity gel. Outcomes were the rate of duodenal distention, delineation rates of the papilla, the time required for delineation, volume of the gel used, and adverse events.ResultsDuodenal distention was excellent, good, and poor in 58%, 34%, and 7% of cases, respectively. The delineation rates of the papilla in the axial and longitudinal views were 98% and 66%, respectively. The median time required to delineate the papilla in each view was 3.1 (range, 1.0-1.4) and 7.9 (1.9-28.6) min; the median volume of the gel used was 80 (30-150) ml and 100 (50-200) ml, respectively. No adverse events were noted.ConclusionsGel immersion-endoscopic ultrasonography provided sufficient duodenal distention, leading to high rates of detection and delineation of the papilla using a small volume of gel within a short time. This method may be useful for the evaluation of the ampullary region.

| S-EPMC9353120 | biostudies-literature

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