Incizia şi excizia endoscopică pentru ampulom vaterian. Paşi consecutivi

Abstract

Introduction. The treatment options for tumors of the ampulla of Vater include endoscopic miniinvasive procedures, local resection and radical pancreaticoduodenectomy. However, pancreaticoduodenectomy is still associated with risc of high morbidity and mortality. Local resection of benigne or malignant ampullomas may not be safety and risc of complications is olso high. Endoscopy and ERCP-related miniinvasive procedures have a considerable importance in diagnosis and consecutive treatment of ampullomas of Vater. Materials and medods. A total 14 patients with ampullary neoplasms were managed from 1997 to 2011. There was 8 male and 6 female mean age 56 (42 - 72), who was treated preoperatively by different gastrointestinal disorders and jaundice in the therapeutic clinics. Duration of preoperative symptomatic period was 1 – 6 months. All patients have had obstructive jaundice during 14 to 45 days. Early colecistectomised in the period from 1 month to 12 years was 5 patients (36%). Diagnostic was based on clinical findings, laboratory test abnormalities, ultrasound (USG) and CT-scan signs of biliary hypertension, radiological (duodenography) and routine endoscopic examination (FEGDS). All patients submitted ERCP and endobiopsy of neoplasm as the first step of combine endosurgical treatment. Consecutive surgical steps was so as: I.Endoscopic sphincterotomy only - 6 (benigne); II.Endoscopic sphincterotomy and open local resection of ampulloma – 2 (benigne); III.Endoscopic sphincterotomy and Whipple procedure – 2 (malignant); IV.Endoscopic sphincterotomy and endoscopic snare resection of ampulloma.- 4 (1-benigne and 3 - maligne). Rezults. Endoscopic sphincterotomy (ES) was succesfull in all of cases and was a suficient procedure for temporary biliary decompression. In 6 of case ES was definitive procedure of treatment. In 2 cases of benigne neoplasm тhe surgical treatment was finished by open local resection of ampulloma. In 2 cases of adenocarcinoma of Vaters papilla, tie patients supported Whipple procedure with good outcome. Open surgical procedure was performed after reducing of obstructive jaundice. Endoscopic snare resection of ampulloma was performed in 1 case of benign ampulloma and 3 cases of adenocarcinoma of Vaters papilla. One endoscopic snare resection was performed in two steps during 3 days because of big size of neoplasm to 4,5 x 5,0 cm. The control endobiopsy during 1 – 3 years after snare resection is negative. Conclusions. 1.Endoscopic sphincterotomy in treatment of Vaters ampulloma is the important step for biliary decompression or as definitive procedure. 2. Endoscopic snare resection of malignant Vaters adenoma is possible with good outcome.