Endoscopic diagnosis and resection therapy of the Tumor of the major duodenal papilla

Endoscopic ultrasonography and intraductal ultrasonography (IDUS) are useful for diagnosing tumor extension of the major duodenal papilla. Especially, IDUS makes it possible to diagnose early cancer that has never been correctly diagnosed by other modalities. On the other hand, we think that endoscopic resection therapy of the tumor that is benign adenoma or early cancer may be initially selected as a curative treatment similar to, endoscopic mucosal resection for early gastric or colonic cancer. Between 1993 and 2007, 91 patients with tumor of the duodenal major papilla underwent, endoscopic resection therapy at our institute. The indication for this therapy was defined as a case with adenoma or early cancer without infiltration into the bile and pancreatic ducts. The tumors were resected in a radical fashion using pure cutting current. Temporary endoscopic pancreatic duct stenting could prevent acute pancreatitis, which is important as an early complication. We have a few cases with late complications, but they were improved conservatively in all cases. We think that endoscopic resection therapy can be assessed as a safe and curative treatment of adenoma of the major duodenal papilla. In addition, it is occasionally estimated as a curative therapy for early cancer.