ABSTRACT
Resumen Introducción y objetivos: los divertículos duodenales periampulares (DDP) son infrecuentes y su hallazgo es incidental. Además, se clasifican en tres tipos según Boix por la cercanía a la ampolla mayor. El objetivo de este estudio fue realizar una descripción de nuestra experiencia con esta anomalía anatómica y demostrar la forma en que esto afecta la tasa de éxito técnica y terapéutica del procedimiento. Material y métodos: se realizó un estudio de corte transversal, con recolección de datos de forma retrospectiva en un período de 5 años de pacientes con divertículos periampulares duodenales. Se evaluó el fracaso terapéutico, complicaciones y dificultad de canulación de la vía biliar. Resultados: se evaluó un total de 214 pacientes, con una relación mujer-hombre de 2,15:1. La distribución de los sujetos por tipo de DDP fue: tipo 1 (29,9 %), tipo 2 (51,9 %) y tipo 3 (18,2 %). La indicación más frecuente de CPRE fue los cálculos del conducto biliar común en un 53,3 %. El DDP tipo 1 presentó mayor dificultad de canulación (11,6 %) y falla terapéutica (28,12 %). Conclusión: la presencia de DDP durante la CPRE se asocia con una mayor falla técnica (falla en la canulación) y falla terapéutica (persistencia de la obstrucción biliar). Además, estas fallas aumentan considerablemente cuando se trata de una papila intradiverticular tipo 1 de la clasificación según Boix. Por lo anterior, se sugiere que los procedimientos endoscópicos biliares en estas condiciones sean realizados por endoscopistas con gran experiencia con el fin de minimizar la probabilidad de falla técnica y terapéutica, y las complicaciones asociadas.
Abstract Introduction and objectives: Periampullary duodenal diverticula are infrequent, and their finding is incidental. They are classified into three types according to Boix due to their proximity to the larger blister. This study aims to describe the experience with this anatomical abnormality and to demonstrate how this affects the technical and therapeutic success rate of the procedure. Materials y Methods: A cross-sectional study was conducted, with retrospective data collection over a 5-year period of patients with periampullary duodenal diverticula. Therapeutic failure, complications, and difficulty of cannulation of the bile duct were evaluated. Results: A total of 214 patients were evaluated, with a female-male ratio of 2.15: 1. The distribution of the subjects by type of PDD was: type 1 (29.9%), type 2 (51.9%), and type 3 (18.2%). The most frequent indication for ERCP was common bile duct stones in 53.3%. Type 1 PDD presented greater difficulty in cannulation (11.6%) and therapeutic failure (28.12%). Conclusion: The presence of PDD during ERCP is associated with greater technical failure (failure in cannulation) and therapeutic failure (persistence of biliary obstruction). In addition, this failures increases considerably when it is a type 1 intradiverticular papilla of the Boix classification. Therefore, it is suggested that biliary endoscopic procedures in these conditions are performed by highly experienced endoscopists to minimize the probability of technical and therapeutic failure and associated complications.
Subject(s)
Humans , Male , Female , Ampulla of Vater , Cholangiopancreatography, Endoscopic Retrograde , Diverticulum , Patients , Therapeutics , Bile Ducts , Cross-Sectional Studies , Data Collection , MethodsABSTRACT
Objective To summarize our experience in the diagnosis and treatment of carcinoma of the papilla of Vater (CPV).Methods From April 2005 to May 2012,21 consecutive patients were enrolled in Dongguan Affiliated Hospital of Southern Medical University.The clinical characteristics,diagnosis,surgical data and follow-up results of these patients were retrospectively analyzed.Results Painless jaundice was the primary symptom in 18 patients.An elevated CEA level was observed in 3 patients preoperatively,while CA19-9 was increased in 10 patients.17 patients with periampullary tumors were detected by MRCP or CT,and in 12 patients,they were detected by ultrasound examination.Gastroscopy was performed in 16 patients,among whom 8 patients were diagnosed with neoplasm of the duodenal papilla initially,and 5 patients were ultimately diagnosed with CPV by pathological examination after biopsy.All the 21 patients were successfully treated with pancreaticoduodenectomy.8 patients developed postoperative complications.No death occurred in the perioperative period.The complications included pancreatic fistula (2 patients),gastroparesis (2 patients),incisional infection (2 patients),gastrointestinal hemorrhage (1 patient) and concurrent gastrointestinal and intraperitoneal haemorrhage (1 patient).A reoperation consisting of pancreaticoduodenal repair and drainage was performed in 1 patient.3 patients underwent adjuvant chemotherapy.Long-term follow up was obtained in 18 patients.The 1-year,3-year and 5-year survival rates were 80.9％,66.7％ and 47.6％,respectively.The longest overall survival was 152 months.Conclusions Early diagnosis of CPV was feasible.Pancreaticoduodenectomy as a treatment strategy for this cancer was safe and effective.
ABSTRACT
In cholangiographic techniques, the close relationship between choledochal cyst and anomalous union of pancreaticobiliary duct has attracted medical attention. There have been rare cases in which the papilla of Vater was found in a position other than its normal position, and such cases have been reported sporadically. However, such cases are interesting in the anatomical context. In this review, we present our experience of choledochal cyst in a 30-month-old boy in whom the papilla of Vater was positioned in the third portion of the duodenum.
Subject(s)
Cholangiography , Choledochal Cyst , Duodenum , Child, PreschoolABSTRACT
Adenosquamous carcinoma of the papilla of Vater is a rare tumor and only a few cases have been reported so far. Here, we report a case of adenosquamous carcinoma in a 76-year-old male who presented with jaundice and right upper quadrant abdominal pain. Ultrasonography and enhanced abdominal CT scans showed dilated common bile duct (CBD) and intrahepatic bile duct (IHD) with a suspicious obstructing mass in distal CBD. On endoscopy, obstructing and ulcerated mass was noted on the papilla of Vater. Histopathological inspection of the biopsied specimens from mass showed adenosquamous cell carcinoma of the papilla of Vater. Since the patient refused operation, we inserted a self-expandable metallic stent in distal CBD. This is the first case report on adenosquamous carcinoma of the papilla of Vater in Korea.
Subject(s)
Aged , Humans , Male , Ampulla of Vater/pathology , Carcinoma, Adenosquamous/diagnosis , Cell Differentiation , Immunohistochemistry , Tomography, X-Ray ComputedABSTRACT
The common bile duct and the duct of Wirsung cojoin at the level of the duodenum, forming the major. papilla of Vater. Existence of a double major papilla, i.e., two neighboring independent papillary structure:, is infrequent. In our endoscopy unit we have experienced one case of double papilla of Vater wherein canulation of the common bile duct and pancreatic duct could be accom plished through either orifice independently.