ABSTRACT
Objective To explore the diagnosis and treatment of endogenous adenoma of the duodenal papilla by endoscopy.Methods Between June 2005 and October 2008,eight patients who had dilated common and intrahepatic bile ducts with strictured opening of the papilla and lower segments shown by B-ultrasonography or MRCP,were enrolled in this study. The patients were assigned to receive ERCP and IDUS for diagnosis and treatment. Results In this series,three patients received pancreatico-duodenectomy because of tubulovillous adenoma (two cases) or tubular adenoma (one case) complicated with moderate atypical epithelial hyperplasia; one of the two cases with tubulovillous adenoma was confirmed as having local cancer by postoperative pathological examination,and then received interventional therapy and embolization because of liver metastasis in 3 months; the patient who had tubular adenoma was diagnosed with local signet ring cell cancer after the operation,and was followed up at 6 and 14 months afterwards by physical examination,which showed no abnormalities. Endoscopic snare papillectomy followed by bile duct stenting for drainage was performed on two patients,one of them was diagnosed with tubulo-papillary adenoma after the surgery and then showed recurrent tumor at 6 months,resulting death at 10 months; the other one was confirmed as having tubulovillous adenoma complicated with moderate atypical epithelial hyperplasia,this patient showed no abnormalities during follow-up at 6 and 12 months. Plastic bile duct stent was employed in one patient with severe atypical epithelial hyperplasia,but was replaced by metal stent because of repeated infection of the bile duct. One patient with papillary adenoma was lost to follow-up after bile duct stenting for intradrainage. One patient refused any treatment for the tubular adenoma; follow-up by phone showed no abnormality in this case in 12 months.Conclusions Endogenous adenoma of the duodenal papilla is rare detected. The tumor is very likely to turn to malignant. Multi-point biopsy is necessary for the patients with hyperplasia of the mucosal and muscle layers.
ABSTRACT
Objective To study on the value and safety of early endoscopic retrograde cholangiopan-creatography (ERCP)and endoscopic sphincterotomy (EST) in acute biliary pancreatitis. Methods Ninety-two patients with acute biliary pancreatitis underwent early ERCP (within 72 hours) and received endoscopic therapy (ERCP group). Another 40 patients with acute biliary pancreatitis were treated conservatively without ERCP (control group). The disappearance of abdominal pain, decrease of serum amylase level, the mean days and costs of hospitalization and complications were observed in all patients. Results In ERCP group, all patients were performed EST, stones in 72 choledocholithiasis patients had been removed with net-basket or air pocket. Ten cases of severe acute biliary pancreatitis received endoscopic pancreatic duct stents drainage. Ninety two cases of acute biliary pancreatitis received endoscopic nasal catheter bile drainage. The days of the disappearance of abdominal pain, the decrease of serum amylase levels, the cost of the hospitalization and the days of the hospitalization were significantly shorter in the early ERCP group than in the control group. The mortalities in ERCP and control group were 8. 3% and 33. 3% respectively. Conclusion Early ERCP endoscopic therapy is a safe procedure has the superiorities in lowering the mortality, hospital days and expense.