Endoscopic Papillectomy – Our experiences

Introduction: More benign papilla tumors have been found with increasing number of upper gastrointestinal endoscopies. Adenoma is the most frequent benign tumour of the papilla with a probability to develop into cancer similarly to the colon adenomas (adenoma-carcinoma sequence). In non-invasive cases endoscopic papillectomy is the choice of the treatment. Our aim was to study our patients with benign papilla tumor in the the last 5 years, retrospectively. Patients & methods: We searched for patients with benign papillary tumors from our web-based ambulatory registry using phrase „endoscopic papillectomy” between 2010 – 2015. Results: We performed endoscopic papillectomy in 20 patients (10 male/10 female), with mean age of 67.7 ± 9.4 years. Five patients (25%) were on anticoagulant and/or antiaggregation treatment, in 2 pts we performed papillectomy under LMWH treatment. Fifteen (75%) pts had biliary dilation at admission, while in only 1 patient had dilated pancreatic duct, at the same time with ongoing pancreatitis. We have performed 2.1 ± 1.4 intervention on average, with a 6-day (3 – 10) median hospital stay. The snare resection was performed in one piece or in piece-meal fashion depending on the size of the adenoma. We inserted biliary plastic stent in 9 pts (45%) and profilactic pancreatic stent in 5 cases (25%). In sum, 5 complications (25%) have occurred, 4 bleeding (20%) (3 required only endoscopic treatment, 1 required blood transfusions) and 1 severe pancreatitis (5%). We had no perforation and mortality. Histology specimen were obtained from majority of cases with most frequent diagnosis of adenoma (83%). Dysplasia was mild in 80%, severe in 20%. The resection margin and completeness of the resection was evaluated by follow up and endoscopic picture. Conclusion: Endoscopic papillectomy is a safe and effetive intervention in our practice. Current guidelines suggest to insert profilactic pancreatic stent after the procedure.