Brief Article
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World J Gastroenterol. Jul 21, 2013; 19(27): 4316-4324
Published online Jul 21, 2013. doi: 10.3748/wjg.v19.i27.4316
Endoscopic papillectomy: Data of a prospective observational study
Uwe Will, Anne-Kathrin Müller, Frank Fueldner, Igor Wanzar, Frank Meyer
Uwe Will, Anne-Kathrin Müller, Frank Fueldner, Igor Wanzar, Department of Gastroenterology, Municipal Hospital, D-07548 Gera, Germany
Frank Meyer, Department of Surgery, University Hospital, 39120 Magdeburg, Germany
Author contributions: Will U designed research; Will U, Müller AK, Fueldner F and Wanzar I analyzed data and corrected the paper; Will U and Wanzar I performed papillectomy; Meyer F and Will U developed conceptual idea, led research meetings on the issue, wrote the draft, corrected the paper.
Correspondence to: Uwe Will, MD, Professor, Department of Gastroenterology, Municipal Hospital, Strasse des Friedens 122, D-07548 Gera, Germany. uwe.will@wkg.srh.de
Telephone: +49-365-8282401 Fax: +49-365-8282402
Received: October 18, 2012
Revised: March 19, 2013
Accepted: April 13, 2013
Published online: July 21, 2013
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.