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1.
Arq. gastroenterol ; 57(3): 300-305, July-Sept. 2020. tab, graf
Article in English | LILACS | ID: biblio-1131675

ABSTRACT

ABSTRACT BACKGROUND: Endoscopic papillectomy has been conceived as a less invasive therapeutic option for treatment of early neoplastic lesions located at the major duodenal papilla. OBJECTIVE: Evaluating patients with early ampullary lesions who underwent curative intent endoscopic papillectomy related to technical success (histopathological tumor margin assessment) and safety (adverse event rate). METHODS: A retrospective study including consecutive patients who underwent curative intent endoscopic papillectomy for demographic, histopathological and pre-/post-procedural clinical assessment. Endpoints were technical success (histopathological residual tumor assessment) and adverse events rates. RESULTS: A total of 21 medical records patients with a female predominance (13 cases, 61.9%) were included. The tumor was incidental in 8 (38%) cases. Negative residual tumor resection margin rate was 72% (15 cases); three of these cases confirmed high-grade dysplasia in the resected specimen, and six cases were invasive neoplasia. Tumoral recurrence was seen in two cases, and median follow-up time was 12 months, with a 23% loss rate (five patients). Six (28.5%) patients had adverse events, all of them early (bleeding and pancreatitis); none of them required surgical intervention and there was no mortality. CONCLUSION: Endoscopic papillectomy allowed for technical successful procedure with complete removal of ampullary neoplastic lesions in the majority of cases with acceptable adverse event rates. Recurrence rate should be carefully assessed in further studies. There was a recent increase in the number of procedures. There was also a low correlation between pre- and post-histopathological assessment regarding the presence of invasive carcinoma and adenoma with high grade dysplasia, with a predominance of superficial neoplastic adenomatous lesions.


RESUMO CONTEXTO: A papilectomia endoscópica tem sido a opção terapêutica menos invasiva no tratamento de tumores precoces que acometem a papila duodenal maior. OBJETIVO: Avaliar pacientes com tumores ampulares precoces submetidos a papilectomia endoscópica com finalidade curativa, com relação ao sucesso técnico (avaliação histopatológica da margem tumoral) e sua segurança (taxa de eventos adversos [EAs]). MÉTODOS: Foram avaliados retrospectivamente dados demográficos, exame histopatológico e evolução clínica pré e pós-procedimento de pacientes consecutivos submetidos a papilectomia endoscópica. Os desfechos avaliados foram o sucesso técnico (avaliação histopatológica de tumor residual) e taxa de EAs. RESULTADOS: Um total de 21 prontuários de pacientes com predominância feminina (13 casos, 61,9%) foi incluído no estudo. O diagnóstico tumoral foi incidental em 8 (38%) casos. A taxa de margem de ressecção negativa foi 72% (15 casos); três destas lesões confirmaram displasia de alto grau (DAG) no espécime ressecado e seis casos de neoplasia invasora. Houve recorrência tumoral em dois casos e a mediana de seguimento foi de 12 meses, com 23% de taxa de perda de seguimento (cinco casos). Seis (28,5%) pacientes apresentaram EAs, todos precoces (hemorragia e pancreatite aguda); nenhum destes necessitou de intervenção cirúrgica e não houve mortalidade. CONCLUSÃO: A papilectomia endoscópica permitiu sucesso técnico, com a completa remoção de lesões neoplásicas ampulares na maioria dos casos com taxa de EAs aceitáveis. A taxa de recorrência tumoral deve ser cuidadosamente avaliada em estudos futuros. Houve um aumento recente do número de procedimentos realizados. Também houve baixa correlação entre o diagnóstico histológico pré e pós-procedimento para a presença de adenocarcinoma invasor e adenoma com DAG, com predomínio de lesões adenomatosas superficiais.


Subject(s)
Humans , Female , Ampulla of Vater/surgery , Common Bile Duct Neoplasms/surgery , Retrospective Studies , Treatment Outcome , Neoplasm Recurrence, Local
2.
Rev. cir. (Impr.) ; 71(3): 261-265, jun. 2019. ilus
Article in Spanish | LILACS | ID: biblio-1058267

ABSTRACT

INTRODUCCIÓN: Los carcinomas adenoneuroendocrinos mixtos (MANEC) son tipos de tumores bifásicos, reconocidos morfológicamente ante la presencia de una formación neoplásica constituida de manera simultánea por epitelio glandular y células neuroendocrinas. Dentro del tracto gastrointestinal, estas neoplasias predominan en el estómago o el colon. Solo 19 casos localizados en la ampolla de Vater han sido reportados por la literatura. OBJETIVO: Reportar un caso de MANEC; revisar la epidemiología, pronóstico y tratamiento de estos tumores. MATERIALES Y MÉTODO: Presentación de caso clínico de una paciente con diagnóstico de adenocarcinoma neuroendocrino mixto de la región ampular. DISCUSIÓN: La presentación clínica, el manejo y el pronóstico son similares al del adenocarcinoma ampular. Se diagnostican con el examen histopatológico de la muestra resecada. Ambos componentes deben ser histológicamente malignos, y cada uno de ellos debe representar al menos el 30% de la lesión. CONCLUSIÓN: Los MANEC ampulares son tumores poco comunes a nivel mundial, siendo éste el primer caso reportado en nuestro instituto.


INTRODUCTION: Mixed adenoneuroendocrine carcinomas (MANEC) are types of biphasic tumors, morphologically recognized in the presence of a neoplastic formation constituted simultaneously by glandular epithelium and neuroendocrine cells. Only 19 cases located in the ampulla of Vater have been reported in the literature. Within the gastrointestinal tract, these neoplasms predominate in the stomach or colon. AIM: Report a case of MANEC; review of the epidemiology, prognosis and treatment of these tumors. MATERIALS AND METHOD: Case presentation of a patient diagnosed with mixed adeno-neuroendocrine carcinoma of the ampullary region. DISCUSSION: The clinical presentation, management and prognosis are similar to ampullary adenocarcinoma. These tumors are diagnosed with a histopathological examination of the resected specimen. Both components must be histologically malignant, and each of them must represent at least 30% of the lesion. CONCLUSION: MANEC of the ampulla are rare tumors worldwide, being this case the first reported in our institute.


Subject(s)
Humans , Female , Middle Aged , Ampulla of Vater/surgery , Adenocarcinoma/surgery , Carcinoma, Neuroendocrine/surgery , Ampulla of Vater/diagnostic imaging , Adenocarcinoma/diagnostic imaging , Cholangiopancreatography, Endoscopic Retrograde , Pancreaticoduodenectomy , Carcinoma, Neuroendocrine/diagnostic imaging
3.
Arq. gastroenterol ; 53(3): 156-162, tab
Article in English | LILACS | ID: lil-787348

ABSTRACT

ABSTRACT Background Bactibilia has several consequences to human health. Objetive Assessing the bile microbiology of patients with biliopancreatic diseases in order to identify bacteria and their possible infectious complications. Methods Retrospective study of 30 bile culture samples from patients with benign and malignant biliopancreatic diseases. The samples were assessed to set the bile microbiological flora and to search for its possible link with comorbidity, carcinogenesis and postoperative infectious complications. Results Thirty bile samples from patients at mean age ≈57.7 years, mostly female (n=18), were assessed. Bactibilia was found in 12 cases, mostly in patients with benign diseases (n=8), older than 50 years (n=23) and female (n=10). Adenocarcinoma of the duodenal papilla (n=9) and cholelithiasis (n=8) were the most common diseases. Escherichia coli (n=5) and Klebsiella sp (n=3) were predominantly found in patients with benign diseases; and Klebsiella sp (n=2) and Streptococcus sp (n=2) were prevalent in cancer patients. There were postoperative infectious complications in seven cases, five of them in bactibilia-associated patients (P=0.084). Conclusion Bactibilia was found in 12 samples and Escherichia coli and Klebsiella sp were most often identified in patients with benign diseases, as well as Streptococcus sp and Klebsiella sp in cancer patients. There was a trend of higher postoperative infectious complication incidence in patients with bactibilia.


RESUMO Contexto Bacteriobilia pode produzir várias consequências para a saúde humana. Objetivo Avaliar a microbiologia da bile de pacientes com doenças biliopancreáticas para identificar bactérias e possíveis consequências. Métodos Estudo retrospectivo microbiológico. Trinta amostras de bile de pacientes com doenças biliopancreáticas benignas e malignas foram avaliadas para determinar a flora microbiológica da bile e procurar alguma possível relação dessa com comorbidades, carcinogênese e complicações infecciosas pós-operatórias. Resultados As amostras de bile foram avaliadas em pacientes, com idade média ≈57,7 anos, a maioria mulheres (n=18). Evidenciou-se bacteriobilia em 12 casos, a maioria em pacientes com doenças benignas (n=8); pacientes com mais de 50 anos (n=23) e mulheres (n=10). As doenças mais comuns foram o adenocarcinoma de papila duodenal (n=9) e a colelitíase (n=8). Escherichia coli (n=5) e Klebsiella sp (n=5) foram as bactérias mais identificadas em pacientes com doenças benignas; sendo a Klebsiella sp (n=2) e o Streptococcus sp (n=2) as que predominaram nos pacientes com cânceres. As complicações pós-operatórias exclusivamente infecciosas ocorreram em sete casos, sendo em cinco desses associados à bacteriobilia (P=0,084). Conclusão Bacteriobilia foi evidenciada em 12 amostras, sendo as bactérias mais identificadas Escherichia coli e Klebsiella sp em pacientes com doenças benignas; e Streptococcus sp e Klebsiella sp nos pacientes com câncer. Existiu uma tendência a maior incidência de complicações infecciosas pós-operatórias em pacientes com bacteriobilia.


Subject(s)
Humans , Male , Female , Adult , Aged , Aged, 80 and over , Young Adult , Ampulla of Vater/microbiology , Bile/microbiology , Adenocarcinoma/microbiology , Common Bile Duct Neoplasms/microbiology , Choledocholithiasis/microbiology , Postoperative Complications , Streptococcus/isolation & purification , Ampulla of Vater/surgery , Adenocarcinoma/surgery , Retrospective Studies , Common Bile Duct Neoplasms/surgery , Choledocholithiasis/surgery , Escherichia coli/isolation & purification , Fever/surgery , Klebsiella/isolation & purification , Middle Aged
4.
Clinics ; 71(1): 28-35, Jan. 2016. tab, graf
Article in English | LILACS | ID: lil-771946

ABSTRACT

The aim of this study is to address the outcomes of endoscopic resection compared with surgery in the treatment of ampullary adenomas. A systematic review and meta-analysis were performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. For this purpose, the Medline, Embase, Cochrane, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scopus and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were scanned. Studies included patients with ampullary adenomas and data considering endoscopic treatment compared with surgery. The entire analysis was based on a fixed-effects model. Five retrospective cohort studies were selected (466 patients). All five studies (466 patients) had complete primary resection data available and showed a difference that favored surgical treatment (risk difference [RD] = -0.24, 95% confidence interval [CI] = -0.44 to -0.04). Primary success data were identified in all five studies as well. Analysis showed that the surgical approach outperformed endoscopic treatment for this outcome (RD = -0.37, 95% CI = -0.50 to -0.24). Recurrence data were found in all studies (466 patients), with a benefit indicated for surgical treatment (RD = 0.10, 95% CI = -0.01 to 0.19). Three studies (252 patients) presented complication data, but analysis showed no difference between the approaches for this parameter (RD = -0.15, 95% CI = -0.53 to 0.23). Considering complete primary resection, primary success and recurrence outcomes, the surgical approach achieves significantly better results. Regarding complication data, this systematic review concludes that rates are not significantly different.


Subject(s)
Humans , Adenoma/surgery , Ampulla of Vater/surgery , Common Bile Duct Neoplasms/surgery , Duodenal Neoplasms/surgery , Endoscopy/methods , Endoscopy/adverse effects , Pancreaticoduodenectomy/methods , Recurrence , Treatment Outcome
5.
Article in Korean | WPRIM | ID: wpr-172541

ABSTRACT

Periampullary diverticulum is commonly found during endoscopy and can occur at any age although its prevalence increases with age. Periampullary diverticular bleeding is a rare and difficult to diagnose during clinical practice because of its unique appearance and location. This often can lead to massive bleeding and interfere with adequate bleeding control. Endoscopic management on duodenal diverticular bleeding is limited compared to colonic diverticular bleeding due to lack of experience. Herein, we report a case of active bleeding from a periampullary diverticulum during bile duct stone extraction diagnosed by side-viewing endoscope and successfully controlled using hemoclips without any complications.


Subject(s)
Aged , Ampulla of Vater/surgery , Cholangiopancreatography, Endoscopic Retrograde , Diverticulum/diagnosis , Gastrointestinal Hemorrhage/etiology , Humans , Male , Surgical Instruments , Tomography, X-Ray Computed
6.
Article in English | WPRIM | ID: wpr-138287

ABSTRACT

When access to a major duodenal papilla or endoscopic retrograde cholangiopancreatography has failed, percutaneous transhepatic cholangioscopic lithotripsy (PTCS-L) may be useful for removing common bile duct (CBD) stones. However, the feasibility and usefulness of percutaneous transhepatic papillary large-balloon dilation (PPLBD) during PTCS-L for the removal of large CBD stones has not been established. We aimed to determine the safety and efficacy of PPLBD for the treatment of large CBD stones. Eleven patients with large CBD stones in whom the access to the major papilla or bile duct had failed were enrolled prospectively. Papillary dilation was performed using a large (12-20 mm) dilation balloon catheter via the percutaneous transhepatic route. Post-procedure adverse events and efficacy of the stone retrieval were measured. The initial success rate of PPLBD was 100%. No patient required a basket to remove a stone after PPLBD. Electrohydraulic lithotripsy was required in 2 (18.2%) patients. The median time to complete stone removal after PPLBD was 17.8 min and no adverse events occurred after PPLBD. Asymptomatic hyperamylasemia was not encountered in any patients. This study indicates that PPLBD is safe and effective for removal of large CBD stones.


Subject(s)
Ampulla of Vater/surgery , Bile Ducts/surgery , Cholangiopancreatography, Endoscopic Retrograde , Choledocholithiasis/surgery , Feasibility Studies , Gallstones/surgery , Humans , Hyperamylasemia , Lithotripsy/adverse effects , Prospective Studies , Sphincterotomy, Endoscopic/methods , Treatment Outcome , Urinary Bladder Calculi/surgery
7.
Article in English | WPRIM | ID: wpr-138286

ABSTRACT

When access to a major duodenal papilla or endoscopic retrograde cholangiopancreatography has failed, percutaneous transhepatic cholangioscopic lithotripsy (PTCS-L) may be useful for removing common bile duct (CBD) stones. However, the feasibility and usefulness of percutaneous transhepatic papillary large-balloon dilation (PPLBD) during PTCS-L for the removal of large CBD stones has not been established. We aimed to determine the safety and efficacy of PPLBD for the treatment of large CBD stones. Eleven patients with large CBD stones in whom the access to the major papilla or bile duct had failed were enrolled prospectively. Papillary dilation was performed using a large (12-20 mm) dilation balloon catheter via the percutaneous transhepatic route. Post-procedure adverse events and efficacy of the stone retrieval were measured. The initial success rate of PPLBD was 100%. No patient required a basket to remove a stone after PPLBD. Electrohydraulic lithotripsy was required in 2 (18.2%) patients. The median time to complete stone removal after PPLBD was 17.8 min and no adverse events occurred after PPLBD. Asymptomatic hyperamylasemia was not encountered in any patients. This study indicates that PPLBD is safe and effective for removal of large CBD stones.


Subject(s)
Ampulla of Vater/surgery , Bile Ducts/surgery , Cholangiopancreatography, Endoscopic Retrograde , Choledocholithiasis/surgery , Feasibility Studies , Gallstones/surgery , Humans , Hyperamylasemia , Lithotripsy/adverse effects , Prospective Studies , Sphincterotomy, Endoscopic/methods , Treatment Outcome , Urinary Bladder Calculi/surgery
8.
Gut and Liver ; : 231-238, 2015.
Article in English | WPRIM | ID: wpr-136377

ABSTRACT

BACKGROUND/AIMS: It is sometimes difficult to incise the distal papillary roof (PR) completely in patients with choledocholiths and choledochoduodenal fistula (CDF). The Iso-Tome(R) (MTW-Endoskopie W. Haag KG), which is helpful in preventing electrical leakage, has good orientation capabilities and can be easily placed at the orifice of the CDF or ampulla of Vater (AV). We aimed to evaluate the efficacy of endoscopic sphincterotomy (ES) with the Iso-Tome(R) for cutting the distal PR. METHODS: Between May 2003 and July 2012, 35 patients were analyzed retrospectively. The distal PR was cut downward and/or upward using the Iso-tome(R) until the pink intrapapillary mucosa was fully exposed. Downward incisions were performed from the opening of the CDF to the orifice of the AV; upward incisions were performed in reverse. RESULTS: Spontaneous or artificial CDF occurred in four and 31 patients, respectively. The technical and therapeutic success rates were 94.3% (33/35) and 94.3% (33/35), respectively. There was no case of electrical damage to the pink intrapapillary mucosa. Adverse events occurred in 2.9% (1/35; 1, mild bleeding) of patients. CONCLUSIONS: The new technique of ES with the Iso-tome(R) is feasible and useful for effectively incising the distal PR in patients with CDF and choledocholiths.


Subject(s)
Adult , Aged , Aged, 80 and over , Ampulla of Vater/surgery , Biliary Fistula/surgery , Choledocholithiasis/surgery , Common Bile Duct Diseases/surgery , Duodenal Diseases/surgery , Female , Humans , Intestinal Fistula/surgery , Male , Middle Aged , Retrospective Studies , Sphincterotomy, Endoscopic/instrumentation , Treatment Outcome
9.
Gut and Liver ; : 231-238, 2015.
Article in English | WPRIM | ID: wpr-136376

ABSTRACT

BACKGROUND/AIMS: It is sometimes difficult to incise the distal papillary roof (PR) completely in patients with choledocholiths and choledochoduodenal fistula (CDF). The Iso-Tome(R) (MTW-Endoskopie W. Haag KG), which is helpful in preventing electrical leakage, has good orientation capabilities and can be easily placed at the orifice of the CDF or ampulla of Vater (AV). We aimed to evaluate the efficacy of endoscopic sphincterotomy (ES) with the Iso-Tome(R) for cutting the distal PR. METHODS: Between May 2003 and July 2012, 35 patients were analyzed retrospectively. The distal PR was cut downward and/or upward using the Iso-tome(R) until the pink intrapapillary mucosa was fully exposed. Downward incisions were performed from the opening of the CDF to the orifice of the AV; upward incisions were performed in reverse. RESULTS: Spontaneous or artificial CDF occurred in four and 31 patients, respectively. The technical and therapeutic success rates were 94.3% (33/35) and 94.3% (33/35), respectively. There was no case of electrical damage to the pink intrapapillary mucosa. Adverse events occurred in 2.9% (1/35; 1, mild bleeding) of patients. CONCLUSIONS: The new technique of ES with the Iso-tome(R) is feasible and useful for effectively incising the distal PR in patients with CDF and choledocholiths.


Subject(s)
Adult , Aged , Aged, 80 and over , Ampulla of Vater/surgery , Biliary Fistula/surgery , Choledocholithiasis/surgery , Common Bile Duct Diseases/surgery , Duodenal Diseases/surgery , Female , Humans , Intestinal Fistula/surgery , Male , Middle Aged , Retrospective Studies , Sphincterotomy, Endoscopic/instrumentation , Treatment Outcome
10.
Gut and Liver ; : 306-312, 2014.
Article in English | WPRIM | ID: wpr-163236

ABSTRACT

BACKGROUND/AIMS: We investigated the efficacy of prophylactic pancreatic stent placement for preventing postprocedure pancreatitis in patients undergoing endoscopic papillectomy. METHODS: This retrospective study included 82 consecutive patients who underwent endoscopic papillectomy for benign ampullary neoplasm at Samsung Medical Center between August 2002 and June 2011. The patients were subdivided into two groups, namely, those who received prophylactic pancreatic stent placement and those who did not. Patient demographics, baseline blood test, tumor characteristics, and endoscopic treatment data were collected. The primary endpoint was postprocedure pancreatitis. RESULTS: There was no difference in the development of postprocedure pancreatitis between the stent group and the no stent group (6/54, 10.5% and 2/28, 7.14%, respectively; p=1.00). At baseline, there were no significant differences between the two groups in terms of their risk factors for pancreatitis except pancreatic duct dye injection. The stent group was more likely to have dye injection than the nonstent group (100% vs 42.8%, p<0.001). However, in a logistic regression analysis, no significant difference was observed in the risk factors for pancreatitis including dye injection. CONCLUSIONS: Our data suggest that routine prophylactic pancreatic duct stent placement in all patients undergoing endoscopic papillectomy may not be necessary and that large-scale prospective studies are required to identify the subgroup of patients who would benefit.


Subject(s)
Adult , Aged , Aged, 80 and over , Ampulla of Vater/surgery , Cholangiopancreatography, Endoscopic Retrograde , Common Bile Duct Neoplasms/surgery , Endoscopy/methods , Female , Humans , Male , Middle Aged , Pancreatic Ducts/surgery , Pancreatitis/prevention & control , Postoperative Complications/prevention & control , Retrospective Studies , Sphincterotomy, Endoscopic/methods , Stents
11.
Gut and Liver ; : 674-679, 2014.
Article in English | WPRIM | ID: wpr-37646

ABSTRACT

BACKGROUND/AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) is considered a high-risk procedure in patients with previous acute coronary syndrome (ACS); however, clinical studies are rare in the literature. The aim of this study was to investigate the safety and efficacy of ERCP in patients with previous ACS. METHODS: We retrospectively reviewed the medical records of patients with previous ACS who underwent ERCP between January 2007 and August 2012. The clinical characteristics, ERCP diagnoses, treatment results, and complications were analyzed. RESULTS: Fifty patients underwent ERCP an average of 41.6 months after ACS. The most common indication for ERCP was calculous cholangitis. After deep biliary cannulation, endoscopic sphincterotomy, biliary stone removal and endoscopic biliary drainage were successfully performed. Immediate postsphincterotomy bleeding occurred in seven patients, which was successfully controlled using endoscopic therapy. Elevation of cardiac troponin I levels were observed in three patients (6%) before ERCP, and all of these patients were diagnosed with pancreatobiliary disease combined with recurrent ACS, which was treated with coronary artery stent insertion (n=2) and balloon angioplasty (n=1). CONCLUSIONS: Therapeutic ERCP is effective and safe in patients with previous ACS. Cardiac troponin I elevation should be considered a warning sign for recurrent ACS in patients who undergo ERCP.


Subject(s)
Acute Coronary Syndrome/blood , Aged , Aged, 80 and over , Ampulla of Vater/surgery , Angioplasty, Balloon, Coronary , Carcinoma/surgery , Cholangiopancreatography, Endoscopic Retrograde/methods , Cholangitis/etiology , Cholelithiasis/complications , Common Bile Duct Neoplasms/surgery , Drainage , Female , Humans , Male , Middle Aged , Recurrence , Retrospective Studies , Risk Assessment , Sphincterotomy, Endoscopic , Stents , Troponin I/blood
12.
Rev. méd. Minas Gerais ; 22(1)jan.-mar. 2012.
Article in Portuguese | LILACS | ID: lil-676590

ABSTRACT

As neoplasias benignas da ampola de Vater são raras. Essas lesões têm propensão à degeneração maligna de 35 a 55%1 e podem ter tamanho relativamente grande (>5 cm) em diâmetro, em geral sendo notadas por sintomas de hemorragia digestiva, obstrução intestinal ou icterícia obstrutiva. Os tumores carcinoides da papila menor também são extremamente raros e são, a maioria, assintomáticos, porém podem apresentar comportamento agressivo na forma de metástases. Este trabalho apresenta um caso raro de um paciente portador de adenoma viloso em ampola de Vater associado ao carcinoide de papila menor.


Benign neoplasias are rare in the ampulla of Vater, and the likelihood of their degenerating to malign tumor is 35 to 55 %1. Benign neoplasias can have a relatively large size (> 5 cm diameter) and are usually noticed upon such symptoms as gastrointestinal bleeding, intestinal obstruction or obstructive jaundice. Carcinoid tumors in the minor duodenal papilla are also extremely rare and usually asymptomatic, but they can be severe in the metastasis form. This paper reports on a rare case of a patient with villous adenoma in the ampulla of Vater associated with carcinoid tumor in the minor duodenal papilla.


Subject(s)
Humans , Female , Middle Aged , Adenoma/complications , Ampulla of Vater/surgery , Carcinoid Tumor , Pancreatic Ducts/surgery
13.
Indian J Cancer ; 2011 Oct-Dec; 48(4): 496-499
Article in English | IMSEAR | ID: sea-144534

ABSTRACT

Gastrointestinal carcinoid tumors represent a group of well-differentiated tumors originating from various neuroendocrine cells located in the gastrointestinal mucosa and submucosa. Consequently, there is diversity in their clinical presentation, incidence at specific anatomic sites, biological behavior, hormone production, morphologic characteristics, and immunophenotype. Periampullary carcinoids are extremely rare and less then 100 patients have been reported in the world literature, that too mostly as case reports. We are reporting two cases of periampullary carcinoids, one of which presented with rare manifestation as gastrointestinal bleed and both are doing well after successful pancreatoduodenectomy.


Subject(s)
Adult , Ampulla of Vater/pathology , Ampulla of Vater/surgery , Carcinoid Tumor/complications , Carcinoid Tumor/pathology , Carcinoid Tumor/surgery , Diagnosis, Differential , Disease-Free Survival , Endoscopy , Female , Gastrointestinal Neoplasms/complications , Gastrointestinal Neoplasms/pathology , Gastrointestinal Neoplasms/surgery , Hemorrhage , Humans , Jaundice, Obstructive/diagnosis , Jaundice, Obstructive/etiology , Male , Middle Aged , Pancreaticoduodenectomy
14.
Rev. méd. Chile ; 139(8): 1015-1024, ago. 2011. ilus
Article in Spanish | LILACS | ID: lil-612216

ABSTRACT

Background: The diagnosis and treatment of periampullary tumors represents a challenge for current medicine. Aim: To review the results of pancreaticoduodenectomy (PDD) in the treatment of periampullary tumors and to identify risk factors that impact the long-term survival. Patients and Methods: We performed a retrospective study of patients who underwent a PDD for periampullary tumors between 1993 and 2009. We reviewed perioperative results and long term survival. We performed a multivariate analysis for long-term survival. Results: A PDD was performed in 181 patients aged 58 ± 12 years (98 females). Piloric preservation was done in 53 percent and a pancreatogastric anastomosis was used in 94 percent of cases. Morbidity was 62 percent and postoperative mortality was 5.5 percent. Pancreatic cancer was the most frequent pathological finding in 41 percent, followed by ampullary cancer in 28 percent and distal bile duct cancer in 16 percent. Median survival was 17 months, with a five years survival of 24 percent. Survival for ampullary tumors was 28 months with a five years survival of 32 percent. The median and five years survival were 14 months and 16 percent for bile duct cancer and 11 months and 14 percent for pancreatic cancer. Multivariate analysis identified tumor type (pancreas /bile duct) and lymph node dissemination as independent predictors of mortality. Conclusions: One quarter of patients experienced long term survival. Mortality predictors were tumor type and lymph node dissemination.


Subject(s)
Female , Humans , Male , Middle Aged , Ampulla of Vater/surgery , Carcinoma, Pancreatic Ductal/surgery , Common Bile Duct Neoplasms/surgery , Pancreatic Neoplasms/surgery , Pancreaticoduodenectomy/mortality , Ampulla of Vater/pathology , Carcinoma, Pancreatic Ductal/mortality , Carcinoma, Pancreatic Ductal/pathology , Common Bile Duct Neoplasms/mortality , Common Bile Duct Neoplasms/pathology , Lymphatic Metastasis , Multivariate Analysis , Pancreatic Neoplasms/mortality , Pancreatic Neoplasms/pathology , Pancreaticoduodenectomy/adverse effects , Retrospective Studies , Survival Rate
15.
Gastroenterol. latinoam ; 22(2): 214-216, abr.-jun. 2011. tab
Article in Spanish | LILACS | ID: lil-661823

ABSTRACT

Ampullary neoplasms may correspond to adenoma or adenocarcinoma. The study of its staging is performed by means of computed tomography, magnetic resonance imaging and endosonography. The appropriate classification of the stages allows for a better planning of treatment. In benign tumors and small selected carcinoma, ampullectomy (endoscopic or surgical) is an alternative. In patients with ampullary neoplasms invading deep extension or showing high risk of recurrence, without evidence of metastasis, pancreatodudodenectomy is the treatment of choice. In those cases with distant metastasis, palliative treatment is indicated.


Las neoplasias ampulares pueden corresponder a adenomas o adenocarcinomas. El estudio de etapificación se realiza con tomografía computada, resonancia magnética y endosonografía. La correcta clasificación en estadíos, permite planificar de mejor forma el tratamiento. En tumores benignos y seleccionados carcinomas pequeños, la ampulectomía (endoscópica o quirúrgica) es una alternativa. En pacientes con neoplasias ampulares que presentan extensión en profundidad o alto riesgo de recurrencia, sin evidencia de metástasis a distancia, estaría indicada la pancreatoduodenectomía. En aquellos casos con metástasis a distancia, se aplican técnicas paliativas.


Subject(s)
Humans , Adenocarcinoma/surgery , Adenoma/surgery , Ampulla of Vater/surgery , Common Bile Duct Neoplasms/surgery , Adenocarcinoma/diagnosis , Adenoma/diagnosis , Ampulla of Vater/pathology , Duodenoscopy , Neoplasm Staging , Common Bile Duct Neoplasms/classification , Common Bile Duct Neoplasms/diagnosis , Pancreaticoduodenectomy , Prognosis
16.
Article in English | IMSEAR | ID: sea-135454

ABSTRACT

Background & objectives: Ampullary cancer is one of the periampullary tumours with better prognosis, but relapses occur early in some patients. This study was carried out to assess whether pancreatoduodenectomy (PDE, Whipple operation) could be a safe therapeutic procedure for elderly patients with periampullary tumours. Methods: Between 2005 and 2007, 19 patients (12 male, 7 female) aged over 65 yr (range 66 and 83 yr) with diagnosis of ampulloma were operated. Results: Of the 19 patients, 6 underwent local surgical ampullectomy with reinsertion of ductus choledochus and Wirsungi’s duct for benign or early cancer lesion and 13 underwent PDE (Whipple operation). Of these 13, only one was in T1 stage, one was in T4 stage, two patients were T3 and the rest in T2 stage. Lesion of lymphatic system had 40 per cent of patients in T2 stage and all in T3 and T4 stages. One patient died of pulmonary embolism several days after operation. Post-operative complications occurred in 3 cases: 1 patient with partial dehiscence of gastroenteroanastomosis – treated by conservative approach, 2 patients with dehiscence of pancreatojejunoanastomosis. Interpretation & conclusions: Diagnosis and therapy of ampullary tumours is multimodal. With careful patient selection, PDE can be performed in elderly people (>65 yr) safely. The post-operative morbidity in this group is essentially influenced by their multi-morbidity.


Subject(s)
Aged , Aged, 80 and over , Ampulla of Vater/pathology , Ampulla of Vater/surgery , Common Bile Duct Diseases/diagnosis , Common Bile Duct Diseases/therapy , Common Bile Duct Neoplasms/surgery , Digestive System Surgical Procedures/methods , Duodenum/surgery , Female , Humans , Male , Prognosis , Risk , Treatment Outcome
17.
Indian J Cancer ; 2011 Jan-Mar; 48(1): 86-93
Article in English | IMSEAR | ID: sea-144417

ABSTRACT

Perioperative management of pancreatic and periampullary cancer poses a considerable challenge to the pancreatic surgeon, anesthesiologist, and the intensive care team. The preoperative surgical evaluation of a pancreatic lesion aims to define the nature of the lesion (malignant or benign), stage the tumor, and to determine resectability or other non-surgical treatment options. Patients are often elderly and may have significant comorbidities and malnutrition. Obstructive jaundice may lead to coagulopathy, infection, renal dysfunction, and adverse outcomes. Routine preoperative biliary drainage can result in higher complication rates, and metal stents may be preferred over plastic stents in selected patients with resectable disease. Judicious use of antibiotics and maintaining fluid volume preoperatively can reduce the incidence of infection and renal dysfunction, respectively. Perioperative fluid therapy with hemodynamic optimization using minimally invasive monitoring may help improve outcomes. Careful patient selection, appropriate preoperative evaluation and optimization can greatly contribute to a favorable outcome after major pancreatic resections.


Subject(s)
Ampulla of Vater/surgery , Common Bile Duct Neoplasms/surgery , Humans , Pancreatic Neoplasms/surgery , Preoperative Care
18.
Rev. chil. cir ; 61(5): 478-481, oct. 2009. ilus
Article in Spanish | LILACS | ID: lil-582110

ABSTRACT

Occasionally hepatectomy for metastases of ampulla of Vater carcinoma can result in a better survival and quality of life of patients. We report a 67 years old male subjected to a duodenopancreatectomy for a carcinoma of the ampulla of Vater that required afterwards a right hepatectomy for metastases. Twenty one months after the second operation and 42 months after the first operation, that patient is asymptomatic and without evidences of relapse.


El tratamiento quirúrgico del carcinoma de ampolla de Vater presenta mejores resultados oncológicos que los del resto de los tumores periampulares. En casos seleccionados, la resección hepática por metástasis de carcinoma de ampolla de Vater extirpado previamente, puede proporcionar supervivencias prolongadas y con buena calidad de vida. Presentamos un paciente de 67 años tratado con duodenopancreatectomía por cáncer de la ampolla de Vater y posteriormente con hepatectomía derecha por metástasis. A los 42 y 21 meses de la primera y segunda intervención respectivamente, permanece asintomático y sin evidencia de enfermedad.


Subject(s)
Humans , Male , Aged , Ampulla of Vater/pathology , Carcinoma/surgery , Carcinoma/secondary , Liver Neoplasms/surgery , Liver Neoplasms/secondary , Common Bile Duct Neoplasms/pathology , Ampulla of Vater/surgery , Hepatectomy , Common Bile Duct Neoplasms/surgery , Pancreaticoduodenectomy , Treatment Outcome
19.
Article in English | IMSEAR | ID: sea-40324

ABSTRACT

OBJECTIVE: A single-institution randomized controlled trial was conducted to compare the results of standard whipple operation (SW) with those of pylorus-preserving pancreaticoduodenectomy (PPPD). MATERIAL AND METHOD: Between January 2000 and December 2004, 27 patients with pancreatic or periampullary adenocarcinoma were enrolled into the study. All patients were randomly allocated to either a SW or a PPPD resection. Patients' characteristics, postoperative mortality and morbidity, and survival up to two years were compared. RESULTS: There were no significant differences in baseline characteristics between the two groups of patients. There were also no significant differences in blood loss and operative time. Delayed gastric emptying (DGE) occurred more frequently in the PPPD group, but other operative complications, hospital mortality, and the length of hospital stay were similar for the two groups. There were no significant survival differences at two years after operation. CONCLUSIONS: SW and PPPD were comparable in terms of operation time, blood loss, operative mortality and morbidity, and survival. Although the incidence of DGE was higher in the PPPD group, the hospital stay was similar for both groups. Both surgical procedures were equally effective for the treatment of pancreatic and periampullary carcinoma.


Subject(s)
Adenocarcinoma/surgery , Aged , Ampulla of Vater/surgery , Female , Gastric Emptying , Humans , Length of Stay , Male , Middle Aged , Pancreatic Neoplasms/surgery , Pancreaticoduodenectomy/methods , Perioperative Care , Postoperative Complications , Postoperative Period , Pylorus/surgery , Survival , Time Factors , Treatment Outcome
20.
Cuad. cir ; 22(1): 30-35, 2008.
Article in Spanish | LILACS | ID: lil-518995

ABSTRACT

Los tumores ampulares corresponden a aquellos ubicados en la unión de los segmentos terminales del conducto pancreático y colédoco. Son poco frecuentes, constituyendo entre un 1 a 2 por ciento de los tumores del tracto digestivo. Se caracterizan por su lento crecimiento y por corresponder a los tumores periampulares de mejor pronóstico. Actualmente está en discusión el enfrentamiento terapéutico, en cuanto al tipo de resección para cada tumor y cada paciente. La postura previa ha sido la resección quirúrgica clásica, no obstante está en boga un manejo conservador. Se da a conocer el caso clínico de un hombre de 53 años, que consulta por cuadro de ictericia progresiva, coluria, acolia y dolor abdominal. La ecotomografía y TC de abdomen son sugerentes de neoplasia periampular. La colangiografia endoscópica retrógrada confirmó un tumor ampular de aproximadamente 3 cm. de diámetro. Se realiza papilotomía, instalación de endoprótesis biliar y biopsia de papila. El estudio histopatológico no descarta una neoplasia invasora, por lo que se realiza ampulectomía endoscópica. La biopsia concluye adenoma túbulopapilar.


Subject(s)
Humans , Male , Middle Aged , Adenocarcinoma/surgery , Adenocarcinoma/pathology , Common Bile Duct Neoplasms/surgery , Common Bile Duct Neoplasms/pathology , Pancreaticoduodenectomy , Ampulla of Vater/surgery , Ampulla of Vater/pathology , Cholangiopancreatography, Endoscopic Retrograde , Treatment Outcome
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