Skip to main content
SpringerLink
Log in

Papillentumoren – endoskopische und/oder chirurgische Therapie?

Tumours of the major duodenal papilla – endoscopic and/or surgical therapy?

  • Schwerpunkt
  • Published:
Der Gastroenterologe Aims and scope

Zusammenfassung

Papillentumoren sind vergleichsweise selten, werden jedoch zunehmend häufiger nicht nur bei Symptomen, sondern auch bei asymptomatischen Patienten im Rahmen endoskopischer Untersuchungen diagnostiziert. Adenome sind hierbei die häufigsten benignen Tumoren. Es besteht jedoch das Risiko einer malignen Entartung, so dass eine komplette Resektion dieser Papillentumoren erforderlich ist. Sowohl chirurgische als auch endoskopische Techniken sind zur Entfernung von Papillentumoren etabliert. Prämaligne Neoplasien können mit hoher Sicherheit endoskopisch therapiert werden, dahingegen sollten Karzinome chirurgisch radikal behandelt werden. Hierbei ist die Prognose des Papillenkarzinoms in entsprechend frühen Tumorstadien ohne Lymphknotenbeteiligung deutlich besser als beim duktalen Adenokarzinom des Pankreas. Welche Methoden als Standard angesehen werden und welche präinterventionellen Untersuchungen durchgeführt werden sollten, ist Ziel dieses Übersichtsartikels.

Abstract

Tumours arising from the major duodenal papilla are rare but are being identified more frequently, either because of the symptoms they produce or because of an increased use of upper endoscopic examination in asymptomatic patients. Most tumours are benign adenomas, but they still have a premalignant potential. Thus, complete resection of the tumours is standard practice. Surgical as well as endoscopic techniques have been established for the resection of ampullary tumours. Premalignant lesions can be endoscopically removed with very good results; however, malignant tumours should be treated by a radical surgical procedure. An overview of available treatment modalities – including surgical resection, endoscopic treatment, and diagnostic procedures – is given.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Perzin KH, Bridge MF (1981) Adenomas of the small intestine: a clinicopathologic review of 51 cases and a study of their relationship to carcinoma. Cancer 48: 799–819

    Article  PubMed  CAS  Google Scholar 

  2. Hartel M, Wente MN, Sido B et al (2005) Carcinoid of the ampulla of Vater. J Gastroenterol Hepatol 20: 676–681

    Article  PubMed  Google Scholar 

  3. Beger HG, Staib L, Schoenberg MH (1998) Ampullectomy for adenoma of the papilla and ampulla of Vater. Langenbecks Arch Surg 383: 190–193

    Article  PubMed  CAS  Google Scholar 

  4. Büchler M, Rampf W, Baczako K et al (1984) Klinik und Feinstruktur des Papillenkarzinoms. Unter besonderer Berücksichtigung der morphologischen Karzinogenese. Dtsch Med Wochenschr 109: 1629–1634

    Article  PubMed  Google Scholar 

  5. Kaiser A, Jurowich C, Schonekas H et al (2002) The adenoma-carcinoma sequence applies to epithelial tumours of the papilla of Vater. Z Gastroenterol 40: 913–920

    Article  PubMed  CAS  Google Scholar 

  6. Matsumoto T, Iida M, Nakamura S et al (2000) Natural history of ampullary adenoma in familial adenomatous polyposis: reconfirmation of benign nature during extended surveillance. Am J Gastroenterol 95: 1557–1562

    Article  PubMed  CAS  Google Scholar 

  7. Norton ID, Geller A, Petersen BT et al (2001) Endoscopic surveillance and ablative therapy for periampullary adenomas. Am J Gastroenterol 96: 101–106

    Article  PubMed  CAS  Google Scholar 

  8. Posner S, Colletti L, Knol J et al (2000) Safety and long-term efficacy of transduodenal excision for tumors of the ampulla of Vater. Surgery 128: 694–701

    Article  PubMed  CAS  Google Scholar 

  9. Yamaguchi K, Enjoji M, Kitamura K (1990) Endoscopic biopsy has limited accuracy in diagnosis of ampullary tumors. Gastrointest Endosc 36: 588–592

    Article  PubMed  CAS  Google Scholar 

  10. Witzigmann H, Möbius C, Uhlmann D et al (2000) Behandlungskonzept von Adenomen der Papilla Vateri. Chirurg 71: 196–201

    PubMed  CAS  Google Scholar 

  11. Kondo S, Takada T, Miyazaki M et al (2008) Guidelines for the management of biliary tract and ampullary carcinomas: surgical treatment. J Hepatobiliary Pancreat Surg 15: 41–54

    Article  PubMed  Google Scholar 

  12. Binmoeller KF, Boaventura S, Ramsperger K, Soehendra N (1993) Endoscopic snare excision of benign adenomas of the papilla of Vater. Gastrointest Endosc 39: 127–131

    Article  PubMed  CAS  Google Scholar 

  13. Han J, Kim MH (2006) Endoscopic papillectomy for adenomas of the major duodenal papilla. Gastrointest Endosc 63: 292–301

    Article  PubMed  Google Scholar 

  14. Cheng CL, Sherman S, Fogel EL et al (2004) Endoscopic snare papillectomy for tumors of the duodenal papillae. Gastrointest Endosc 60: 757–764

    Article  PubMed  Google Scholar 

  15. Itoi T, Tsuji S, Sofuni A et al (2009) A novel approach emphasizing preoperative margin enhancement of tumor of the major duodenal papilla with narrow-band imaging in comparison to indigo carmine chromoendoscopy (with videos). Gastrointest Endosc 69: 136–141

    Article  PubMed  Google Scholar 

  16. Seifert E, Schulte F, Stolte M (1992) Adenoma and carcinoma of the duodenum and papilla of Vater: a clinicopathologic study. Am J Gastroenterol 87: 37–42

    PubMed  CAS  Google Scholar 

  17. Menzel J, Poremba C, Dietl KH et al (1999) Tumors of the papilla of Vater–inadequate diagnostic impact of endoscopic forceps biopsies taken prior to and following sphincterotomy. Ann Oncol 10: 1227–1231

    Article  PubMed  CAS  Google Scholar 

  18. Sauvanet A, Chapuis O, Hammel P et al (1997) Are endoscopic procedures able to predict the benignity of ampullary tumors? Am J Surg 174: 355–358

    Article  PubMed  CAS  Google Scholar 

  19. Tio TL, Tytgat GN, Cikot RJ et al (1990) Ampullopancreatic carcinoma: preoperative TNM classification with endosonography. Radiology 175: 455–461

    PubMed  CAS  Google Scholar 

  20. Cannon ME, Carpenter SL, Elta GH et al (1999) EUS compared with CT, magnetic resonance imaging, and angiography and the influence of biliary stenting on staging accuracy of ampullary neoplasms. Gastrointest Endosc 50: 27–33

    Article  PubMed  CAS  Google Scholar 

  21. Maluf-Filho F, Sakai P, Cunha JE et al (2004) Radial endoscopic ultrasound and spiral computed tomography in the diagnosis and staging of periampullary tumors. Pancreatology 4: 122–128

    Article  PubMed  CAS  Google Scholar 

  22. Itoh A, Goto H, Naitoh Y et al (1997) Intraductal ultrasonography in diagnosing tumor extension of cancer of the papilla of Vater. Gastrointest Endosc 45: 251–260

    Article  PubMed  CAS  Google Scholar 

  23. Menzel J, Hoepffner N, Sulkowski U et al (1999) Polypoid tumors of the major duodenal papilla: preoperative staging with intraductal US, EUS, and CT–a prospective, histopathologically controlled study. Gastrointest Endosc 49: 349–357

    Article  PubMed  CAS  Google Scholar 

  24. Desilets DJ, Dy RM, Ku PM et al (2001) Endoscopic management of tumors of the major duodenal papilla: Refined techniques to improve outcome and avoid complications. Gastrointest Endosc 54: 202–208

    PubMed  CAS  Google Scholar 

  25. Norton ID, Gostout CJ, Baron TH et al (2002) Safety and outcome of endoscopic snare excision of the major duodenal papilla. Gastrointest Endosc 56: 239–243

    Article  PubMed  Google Scholar 

  26. Bohnacker S, Seitz U, Nguyen D et al (2005) Endoscopic resection of benign tumors of the duodenal papilla without and with intraductal growth. Gastrointest Endosc 62: 551–560

    Article  PubMed  Google Scholar 

  27. Catalano MF, Linder JD, Chak A et al (2004) Endoscopic management of adenoma of the major duodenal papilla. Gastrointest Endosc 59: 225–232

    Article  PubMed  Google Scholar 

  28. Vogt M, Jakobs R, Benz C et al (2000) Endoscopic therapy of adenomas of the papilla of Vater. A retrospective analysis with long-term follow-up. Dig Liver Dis 32: 339–345

    Article  PubMed  CAS  Google Scholar 

  29. Harewood GC, Pochron NL, Gostout CJ (2005) Prospective, randomized, controlled trial of prophylactic pancreatic stent placement for endoscopic snare excision of the duodenal ampulla. Gastrointest Endosc 62: 367–370

    Article  PubMed  Google Scholar 

  30. Adler DG, Qureshi W, Davila R et al (2006) The role of endoscopy in ampullary and duodenal adenomas. Gastrointest Endosc 64: 849–854

    Article  PubMed  Google Scholar 

  31. Duffy JP, Hines OJ, Liu JH et al (2003) Improved survival for adenocarcinoma of the ampulla of Vater: fifty-five consecutive resections. Arch Surg 138: 941–948

    Article  PubMed  Google Scholar 

  32. Todoroki T, Koike N, Morishita Y et al (2003) Patterns and predictors of failure after curative resections of carcinoma of the ampulla of Vater. Ann Surg Oncol 10: 1176–1183

    Article  PubMed  Google Scholar 

  33. de Castro SM, van Heek NT, Kuhlmann KF et al (2004) Surgical management of neoplasms of the ampulla of Vater: local resection or pancreatoduodenectomy and prognostic factors for survival. Surgery 136: 994–1002

    Article  Google Scholar 

  34. Brown KM, Tompkins AJ, Yong S et al (2005) Pancreaticoduodenectomy is curative in the majority of patients with node-negative ampullary cancer. Arch Surg 140: 529–532

    Article  PubMed  Google Scholar 

  35. Di Giorgio A, Alfieri S, Rotondi F et al (2005) Pancreatoduodenectomy for tumors of Vater’s ampulla: report on 94 consecutive patients. World J Surg 29: 513–518

    Article  Google Scholar 

  36. Yokoyama N, Shirai Y, Wakai T et al (2005) Jaundice at presentation heralds advanced disease and poor prognosis in patients with ampullary carcinoma. World J Surg 29: 519–523

    Article  PubMed  Google Scholar 

  37. Qiao QL, Zhao YG, Ye ML et al (2007) Carcinoma of the ampulla of Vater: factors influencing long-term survival of 127 patients with resection. World J Surg 31: 137–143

    Article  PubMed  Google Scholar 

  38. Berberat PO, Kunzli BM, Gulbinas A et al (2009) An audit of outcomes of a series of periampullary carcinomas. Eur J Surg Oncol 35: 187–191

    PubMed  CAS  Google Scholar 

  39. Allema JH, Reinders ME, van Gulik TM et al (1995) Results of pancreaticoduodenectomy for ampullary carcinoma and analysis of prognostic factors for survival. Surgery 117: 247–253

    Article  PubMed  CAS  Google Scholar 

  40. Talamini MA, Moesinger RC, Pitt HA et al (1997) Adenocarcinoma of the ampulla of Vater. A 28-year experience. Ann Surg 225: 590–599

    Article  PubMed  CAS  Google Scholar 

  41. Tran TC, Vitale GC (2004) Ampullary tumors: endoscopic versus operative management. Surg Innov 11: 255–263

    Article  PubMed  Google Scholar 

  42. Halsted WH (1899) Contributions to the surgery of the bile passages, especially of the common bile duct. Boston Med Surg J 141: 645–652

    Google Scholar 

  43. Branum GD, Pappas TN, Meyers WC (1996) The management of tumors of the ampulla of Vater by local resection. Ann Surg 224: 621–627

    Article  PubMed  CAS  Google Scholar 

  44. Beger HG, Treitschke F, Gansauge F et al (1999) Tumor of the ampulla of Vater: experience with local or radical resection in 171 consecutively treated patients. Arch Surg 134: 526–532

    Article  PubMed  CAS  Google Scholar 

  45. Sakorafas GH, Sarr MG (1999) Local excision of periampullary villous tumours of the duodenum. Eur J Surg Oncol 25: 90–93

    Article  PubMed  CAS  Google Scholar 

  46. Clary BM, Tyler DS, Dematos P et al (2000) Local ampullary resection with careful intraoperative frozen section evaluation for presumed benign ampullary neoplasms. Surgery 127: 628–633

    Article  PubMed  CAS  Google Scholar 

  47. Paramythiotis D, Kleeff J, Wirtz M et al (2004) Still any role for transduodenal local excision in tumors of the papilla of Vater? J Hepatobiliary Pancreat Surg 11: 239–244

    Article  PubMed  Google Scholar 

  48. Schoenberg MH, Treitschke F, Harada N, Beger HG (1998) Benign tumour of the ampulla of Vater: surgical treatment and prognosis. Eur J Surg 164: 765–770

    Article  PubMed  CAS  Google Scholar 

  49. Woo SM, Ryu JK, Lee SH et al (2009) Feasibility of endoscopic papillectomy in early stage ampulla of Vater cancer. J Gastroenterol Hepatol 24: 120–124

    Article  PubMed  Google Scholar 

  50. Lee SY, Jang KT, Lee KT et al (2006) Can endoscopic resection be applied for early stage ampulla of Vater cancer? Gastrointest Endosc 63: 783–788

    Article  PubMed  Google Scholar 

  51. Ito K, Fujita N, Noda Y et al (2004) Modes of spread in early ampullary cancer in terms of establishing proper indications for endoscopic papillectomy. Dig Endosc 16: 224–228

    Article  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Medizinische Klinik C, Klinikum Ludwigshafen, Ludwigshafen, Deutschland

    F. Schorr & J.F. Riemann

  2. Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    M.N. Wente & M.W. Büchler

Authors
  1. F. Schorr
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M.N. Wente
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J.F. Riemann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M.W. Büchler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to F. Schorr.

Additional information

*F. Schorr und M.N. Wente haben gleichen Anteil an dieser Arbeit und teilen sich die Erstautorenschaft.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schorr, F., Wente, M., Riemann, J. et al. Papillentumoren – endoskopische und/oder chirurgische Therapie?. Gastroenterologe 4, 403–410 (2009). https://doi.org/10.1007/s11377-009-0291-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11377-009-0291-5

Schlüsselwörter

Keywords

Search

Navigation