Safety and outcome of endoscopic snare excision of the major duodenal papilla.

Ian D. Norton, Christopher J. Gostout, Todd H. Baron, Alex Geller, Bret Thomas Petersen, Maurits J. Wiersema

Research output: Contribution to journalArticle

186 Citations (Scopus)

Abstract

BACKGROUND: The optimal management of adenoma of the major duodenal papilla is not established. Options include surgical excision, endoscopic ablative techniques, snare excision, and observation with periodic biopsies. The aims of this retrospective study were to determine the safety and outcome of snare excision of the papilla. METHODS: Twenty-eight snare excisions of the papilla were performed in 26 patients. Sixteen had familial adenomatous polyposis. In 22 procedures, a minisnare was used, and in 6 cases a prototype snare was designed for excision of the papilla. Pancreatic stents were placed as a prophylactic measure at the discretion of the endoscopist (n = 10). RESULTS: Histopathologically, resected tissue included 25 adenomas, 1 inflammatory polyp, 1 invasive malignancy, and 1 normal papilla. Immediate complications were minor bleeding (n = 2), mild pancreatitis (n = 4) and a duodenal perforation (n = 1). The presence (n = 10) or absence (n = 18) of a pancreatic stent did not correlate with subsequent pancreatitis (2 in each group, p = NS). Follow-up was available for 21 patients (median, 9 months; range, 2-32 months). Pancreatic duct stenosis at the papillectomy site resulted in pancreatitis in 2 patients (17%) at, respectively, 4 months and 24 months. Follow-up endoscopy revealed recurrent/residual adenomatous tissue in 2 (10%). CONCLUSIONS: Snare excision of the major duodenal papilla was well tolerated. Most complications were mild except for a small duodenal perforation. Stenosis of the pancreatic duct orifice with pancreatitis may be a late complication.

Original languageEnglish (US)
Pages (from-to)239-243
Number of pages5
JournalGastrointestinal Endoscopy
Volume56
Issue number2
StatePublished - Aug 2002

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Ampulla of Vater
Pancreatitis
Safety
Pancreatic Ducts
Adenoma
Stents
Pathologic Constriction
Adenomatous Polyposis Coli
Polyps
Endoscopy
Retrospective Studies
Observation
Hemorrhage
Biopsy
Neoplasms

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Norton, I. D., Gostout, C. J., Baron, T. H., Geller, A., Petersen, B. T., & Wiersema, M. J. (2002). Safety and outcome of endoscopic snare excision of the major duodenal papilla. Gastrointestinal Endoscopy, 56(2), 239-243.

Safety and outcome of endoscopic snare excision of the major duodenal papilla. / Norton, Ian D.; Gostout, Christopher J.; Baron, Todd H.; Geller, Alex; Petersen, Bret Thomas; Wiersema, Maurits J.

In: Gastrointestinal Endoscopy, Vol. 56, No. 2, 08.2002, p. 239-243.

Research output: Contribution to journalArticle

Norton, ID, Gostout, CJ, Baron, TH, Geller, A, Petersen, BT & Wiersema, MJ 2002, 'Safety and outcome of endoscopic snare excision of the major duodenal papilla.', Gastrointestinal Endoscopy, vol. 56, no. 2, pp. 239-243.
Norton ID, Gostout CJ, Baron TH, Geller A, Petersen BT, Wiersema MJ. Safety and outcome of endoscopic snare excision of the major duodenal papilla. Gastrointestinal Endoscopy. 2002 Aug;56(2):239-243.
Norton, Ian D. ; Gostout, Christopher J. ; Baron, Todd H. ; Geller, Alex ; Petersen, Bret Thomas ; Wiersema, Maurits J. / Safety and outcome of endoscopic snare excision of the major duodenal papilla. In: Gastrointestinal Endoscopy. 2002 ; Vol. 56, No. 2. pp. 239-243.
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