Endoscopic papillectomy: Data of a prospective observational study

Core Tip

Core tip: Taken together, endoscopic ultrasonography is an essential and sufficient diagnostic tool and plays an eminent role in the diagnostic spectrum to preoperatively clarify lesions and diseases of the papilla in conjunction with the competent postinterventional histopathological investigation of a specimen. Endoscopic papillectomy with curative intention is a feasible and safe approach to treat adenomas of the papilla, i.e., it is only reasonable if there is no infiltrating tumor growth. In high-risk patients with carcinoma of the papilla but no hints of deep infiltrating tumor growth, endoscopic papillectomy can be considered a reasonable treatment option with reduced risk and an approximately 80% probability of no recurrence if an R0 resection can be achieved. In patients with jaundice and in case the catheter can not be introduced into the papilla, papillectomy may help to get access to the bile duct to avoid more traumatic surgery. Endoscopic papillectomy is therefore not only used for therapeutic but also for diagnostic purpose. There is a high clinical value of endoscopic papillectomy for well defined indications not only for adenoma but also for carcinoma/neuroendocrine tumor/lymphoma (uT1 and high-risk patient), and adenomyomatosis. Follow-up investigations according to a defined schedule appear to be reasonable including macroscopic assessment, taking a representative biopsy and subsequent histopathological investigation. In addition, continuous systematic investigation of endoscopic papillectomy in daily clinical practice is indicated for the purpose of quality assurance.