Giant laterally spreading tumors of the papilla: endoscopic features, resection technique, and outcome (with videos)

Gastrointest Endosc. 2010 May;71(6):967-75. doi: 10.1016/j.gie.2009.11.021. Epub 2010 Mar 11.


Background: Successful endoscopic treatment of conventional papillary adenomas is well described. However, many authors recommend surgical resection for larger lesions with extrapapillary extension.

Objective: To describe the classification, technique, and outcome for the endoscopic resection of giant laterally spreading tumors of the papilla (LST-P).

Design: Single-center case series.

Settings: Tertiary referral academic gastroenterology unit.

Patients: Patients referred for endoscopic treatment of LST-P.

Intervention: Pre-resection staging and single-session endoscopic removal of papillary adenomas. For those classified as LST-P (>30 mm, extending beyond the papilla onto the duodenal wall and involving as much as two thirds of the duodenal circumference), a standardized single-session EMR technique was used.

Main outcome measurements: Technical success, complications, and adenoma recurrence for single-session removal of LST-P. Outcomes were compared with those of conventional ampullary adenoma resection during the same period.

Results: Twenty-five patients with ampullary adenomas were referred. In 10 patients identified with LST-P (mean age 70.2 years; adenoma size 30-80 mm), combination EMR and papillectomy was performed in a single session. The median admission duration was 1 night (range 0-35). Complications included bleeding (30%) and cholecystitis (10%), with no cases of pancreatitis or perforation. Adenoma recurrence at 3 months was found in 1 patient (10%). Complication and recurrence rates in smaller (<30 mm) ampullary adenoma resections were not significantly different.

Limitations: A relatively uncommon entity and thus small sample size.

Conclusions: Endoscopic resection of carefully staged LST-P is a viable therapeutic alternative to surgery. In experienced hands, the outcomes are comparable to those for conventional ampullary adenomas.

MeSH terms

  • Adenoma / diagnosis*
  • Adenoma / surgery*
  • Adult
  • Aged
  • Aged, 80 and over
  • Ampulla of Vater*
  • Duodenal Neoplasms / diagnosis*
  • Duodenal Neoplasms / surgery*
  • Duodenoscopy
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Video Recording