Features of diagnosis and treatment of ampullary adenomas of the duodenum with intraductal spread type III and IV

doi:https://doi.org/10.17116/hirurgia202603149

OBJECTIVE

To evaluate diagnostic features of large ampullary adenomas of the duodenum using endosonography, as well as to assess advantages of precise approach to resection of complex adenomas with intraductal component.

MATERIAL AND METHODS

Over the past 15 years, 86 patients with type III and IV adenomas underwent endoscopic intraluminal treatment. Among them, 19 patients had type III adenomas, and 67 patients had type IV adenomas. Involvement of common bile duct was observed in 49 patients, pancreatic duct — in 17 patients, 20 patients had simultaneous involvement of both ducts. Mean length of adenomatous component in the bile duct was 10.3 cm, in the main pancreatic duct — 6.2 cm. Mean size of extraduodenal part of type IV adenomas was 27.7 mm.

RESULTS

Technical success was achieved in all cases. Endoscopic papillectomy was performed in 22% of patients with type III adenomas. In 16% of cases, endoscopic papillectomy was supplemented with high-frequency electrosurgical ablation of intraductal adenoma, in 6% of cases — intraductal radiofrequency ablation. Among patients with type IV adenomas, endoscopic papillectomy was performed in 78% of patients. Of these, 48% underwent additional resection of intestinal mucosa, and 9% underwent dissection in submucosal layer. High-frequency electrosurgical ablation was applied to remove intraductal adenoma in 54% of cases, while intraductal radiofrequency ablation was used in 23% of cases. The incidence of postoperative complications was 20.9% (18 patients). Residual fragments of adenoma were detected in 13% (11 patients) of cases, and recurrence of adenoma was observed in 5% of cases. These patients underwent redo endoscopic interventions with successful total excision of adenomas.

CONCLUSION

Various endoscopic techniques based on classification of adenomas, as well as a staged approach to treatment ensures high efficacy and safety in total resection of complex neoplasms of the major duodenal papilla.

Keywords:

adenoma of the major duodenal papilla

endosonography

duodenoscopy

papillectomy

radiofrequency ablation

intraductal growth

endoscopic classification

Received:

05.03.2025

Accepted:

29.03.2025

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References:

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