Rationale for endoscopic management of adenoma of the papilla of Vater: options and limitations

Background: Several studies and our own results prove that endoscopic thera py in selected cases of benign adenomas is safe and technically feasible. I n patients refusing surgery or patients with high comorbidity and poor phys ical health status, endoscopic resection is an excellent alternative. Discu ssion. The decision for endoscopic or surgical excision of adenomas is dete rmined by general health status, histology, size, location, and depth of th e lesion. In carcinoma of the papilla of Vater it is important to assess th e tumoral ductal infiltration correctly to determine whether endoscopic res ection is a viable option. Intraductal ultrasound is essential before initi ating treatment and it therefore contributes to conservative therapy in pat ients with tumors of the papilla of Vater. Temporary placement of a short p ancreatic duct stent may protect against pancreatitis and might allow more excessive ablation of adenomatous tissue, especially around the pancreatic duct orifice. After endoscopic sphincterotomy, biliary and pancreatic endop rostheses can be inserted easily in cases of obstructed pathways or cholang itis and pancreatitis due to tumor obstruction. Argon plasma coagulation ca n be used to treat oozing tumor hemorrhages or to vaporize tumoral residues after endoscopic snare resection. Endoscopic surveillance is essential aft er surgical or endoscopic resection of adenomas of the papilla of Vater.