Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0001430 (adenoma)
 21,222 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Benign tumours of the ampulla of Vater are rare and histologically mostly villous or tubulovillous adenomas. The frequency of malignant lesion in an adenoma of the papilla figures around 26%. Villous adenoma of the ampulla is considered as premalignant lesion. Various techniques have been advocated ranging from simple excision of the ampullary tumour and the contiguous duodenal mucosa to wide resection of the mass including the papilla and adjacent duodenal, ductal, and pancreatic tissue. In this study, 41 patients suffering from a benign tumor of the Ampulla of Vater were examined. Sixty-six percent of all patients exhibited a villous or tubulovillousadenoma with medium or severe degree of dysplasia. Thirty-six patients were treated with local resection of the ampulla, using ampullectomy in 33 patients. In 5 of the 41 patients pylorus-preserving duodenopancreatectomy was applied. The median follow-up of 42 month showed no evidence of recurrent disease. Ampullectomy is an adequate way of treating benign ampullary lesions, but, precise technique is important. The decision-making should be based on histological examination of preoperative biopsy specimens and of operative frozen sections, by an experienced pathologist. If the histology of the ampullary lesion is uncertain, pylorus-preserving partial pancreaticoduodenectomy is justified in patients with low perioperative risks, and if this extended procedure can be done safely by an experienced surgeon.
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PMID:Local resection of benign periampullary tumors. 1043 25

Background: Lesions of the Ampulla of Vater are a rare condition and represent <10% of peri-ampullary neoplasms. Nevertheless, ampullary adenomas have the potential for malignant transformation to ampullary carcinomas by an adenoma-to-carcinoma sequence. Thus, adequate patient selection and complete resection (R0) of non-invasive ampullary lesions either by endoscopic papillectomy (EP), surgical ampullectomy (SA), or pancreaticoduodenectomy (PD) is essential. Although PD was traditionally performed, recent studies reported considerable efficacy and fewer complications following EP and SA. Since consistent comparative data are lacking, the Endoscopic Papillectomy vs. Surgical Ampullectomy vs. Pancreaticoduodectomy (ESAP) study will provide evidence for a therapeutic standard and post procedure morbidity in ampullary lesions. Methods: International multicenter retrospective study. Adult patients (>18 years of age) who underwent SA or PD for ampullary neoplasm between 2004 and 2018 or EP between 2007 and 2018 will be evaluated. Main inclusion criteria are ampullary lesions strictly located to the ampulla. This includes adenoma, adenocarcinoma (T1 and T2), neuroendocrine tumors, gastrointestinal stroma tumors and other rare conditions. Exclusion criteria are peri-ampullary lesions, e.g., from the duodenal wall or the head of the pancreas, and interventions for tumor stages higher than T2. The main objective of this study is to analyze rates of complete resection (R0), recurrence and necessity for complementary interventions following EP, SA, and PD. Treatment-quality for each procedure will be defined by morbidity, mortality and complication rates and will be compared between EP, SA, and PD. Secondary objectives include outcome for patients with incomplete resection or initially understated tumors, lesions of the minor papilla, hereditary syndromes, neuroendocrine tumors, mesenchymal lesions, and other rare conditions. Additionally, we will analyze therapy by argon plasma coagulation and radiofrequency ablation. Furthermore, outcome in curative and palliative interventions can be distinguished. Conclusion: The ESAP study will provide evidence for therapeutic algorithms and data for the implementation of guidelines in the treatment of different types of ampullary tumors, including recurrent, or incomplete resected lesions.
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PMID:Study Protocol of the ESAP Study: Endoscopic Papillectomy vs. Surgical Ampullectomy vs. Pancreaticoduodenectomy for Ampullary Neoplasm-A Pancreas2000/EPC Study. 3243 44