Endoscopic classification of major duodenal papilla adenomas

   Aim. To introduce the developed endoscopic classification of major duodenal papilla adenomas.

   Materials and methods. In 2000–2023 period, 149 patients with neoplasms of the major duodenal papilla underwent comprehensive examinations and surgical interventions. 134 cases involved endoscopic removal of papilla tumors.

   Results. Radical removal of the major papilla adenoma was performed in 90.5 % of cases. 16.6 % of cases revealed complications as follows: postmanipulation pancreatitis in 10 (7.9 %) cases, bleeding in 7 (5.5 %), and duodenal perforation in 4 (3.1 %). 1–3 year follow-up period revealed residual adenomatous overgrowths in 9.5 % of cases. An endoscopic classification of major papilla adenomas was developed, thereby leading to a decrease in the
complication and re-intervention rates. The classification enables the character of intraductal spread of adenomas to be specified and indications for their endoscopic excision to be determined.

   Conclusion. The developed endoscopic classification of major duodenal papilla adenomas contributes to selection of the most effective and safe method of surgical intervention. An application of the classification implies unification of an endoscopic description of the tumor and consistency in patient monitoring by different specialists.

1. Panzeri F., Crippa S., Castelli P., Aleotti F., Pucci A., Partelli S., Zamboni G., Falconi M. Management of ampullary neoplasms: a tailored approach between endoscopy and surgery. World J. Gastroenterol. 2015; 21 (26): 7970–7987. doi: 10.3748/wjg.v21.i26.7970

2. Bohnacker S., Seitz U., Nguyen D., Thonke F., Seewald S., de Weerth A., Ponnudurai R., Omar S., Soehendra N. Endoscopic resection of benign tumors of the duodenal papilla without and with intraductal growth. Gastrointest. Endosc. 2005; 62 (4): 551–560. doi: 10.1016/j.gie.2005.04.053

3. Ardengh J.C., Kemp R., Lima-Filho É.R., Dos Santos J.S. Endoscopic papillectomy: the limits of the indication, technique and results. World J. Gastrointest. Endosc. 2015; 7 (10): 987–994. doi: 10.4253/wjge.v7.i10.987

4. Starkov Yu.G., Vagapov A.I., Zamolodchikov R.D., Dzhantukhanova S.V., Ibragimov A.S. Intraluminal endoscopic complex approach in the treatment of a patient with adenoma of the major duodenal papilla, choledocholithiasis and stricture of the terminal common bile duct. Experimental and Clinical Gastroenterology. 2023; 211 (3): 161–167. doi: 10.31146/1682-8658-ecg-211-3-161-167 (In Russian)

5. Hyun J.J., Lee T.H., Park J.S., Han J.H., Jeong S., Park S.M., Lee H.S., Moon J.H., Park S.H. A prospective multicenter study of submucosal injection to improve endoscopic snare papillectomy for ampullary adenoma. Gastrointest. Endosc. 2017; 85 (4): 746–755. doi: 10.1016/j.gie.2016.08.013

6. De Palma G.D., Luglio G., Maione F., Esposito D., Siciliano S., Gennarelli N., Cassese G., Persico M., Forestieri P. Endoscopic snare papillectomy: a single institutional experience of a standardized technique. A retrospective cohort study. Int. J. Surg. 2015; 13 (1): 180–183. doi: 10.1016/j.ijsu.2014.11.045

7. Nedoluzhko I.Yu., Khon E.I., Shishin K.V. Endoscopic papillectomy for tumors of the major duodenal papilla. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2019; 24 (1): 36–42. doi: 10.16931/1995-5464.2019136-42 (In Russian)

8. Nedoluzhko I.Yu., Khon E.I., Shishin K.V., Shumkina L.V., Kurushkina N.A. Endoscopic treatment of benign ampullary tumors. Russian Journal of Evidence-Based Gastroenterology. 2021; 10 (4): 6774. doi: 10.17116/dokgastro20211004167 (In Russian)

9. Bassi C., Marchegiani G., Giuliani T., Di Gioia A., Andrianello S., Zingaretti C.C., Brentegani G., De Pastena M., Fontana M., Pea A., Paiella S., Malleo G., Tuveri M., Landoni L., Esposito A., Casetti L., Butturini G., Falconi M., Salvia R. Pancreatoduodenectomy at the Verona Pancreas

10. Institute: the evolution of indications, surgical techniques, and outcomes: a retrospective analysis of 3000 consecutive cases. Ann. Surg. 2022; 276 (6): 1029–1038. doi: 10.1097/SLA.0000000000004753

11. Laleman W., Verreth A., Topal B., Aerts R., Komuta M., Roskams T., Van der Merwe S., Cassiman D., Nevens F., Verslype C., Van Steenbergen W. Endoscopic resection of ampullary lesions: a single-center 8-year retrospective cohort study of 91 patients with long-term follow-up. Surg. Endosc. 2013; 27 (10): 3865–3876. doi: 10.1007/s00464-013-2996-2

12. Rustagi T., Irani S., Reddy D.N., Abu Dayyeh B.K., Baron T.H., Gostout C.J., Levy M.J., Martin J., Petersen B.T., Ross A., Topazian M.D. Radiofrequency ablation for intraductal extension of ampullary neoplasms. Gastrointest. Endosc. 2017; 86 (1): 170–176. doi: 10.1016/j.gie.2016.11.002

13. Mensah E.T., Martin J., Topazian M. Radiofrequency ablation for biliary malignancies. Curr. Opin. Gastroenterol. 2016; 32 (3): 238–243. doi: 10.1097/MOG.0000000000000258

14. Rustagi T., Jamidar P.A. Intraductal radiofrequency ablation for management of malignant biliary obstruction. Dig. Dis. Sci. 2014; 59 (11): 2635–2641. doi: 10.1007/s10620-014-3237-9