Summary
Tumors of the papilla of Vater, should be separated from periampullary tumors. They
are not always malignant, and recent data from endoscopy series, and pathology studies,
supports the adenoma-carcinoma sequence at this level. Adenomas are tubular or villous
and are classified according to the degree of dysplasia. The endoscopic pattern separates
exophytic tumors, sessile and easily detected, from intracanalar tumors usually detected
after sphincterotomy. The malignancy of an exophytic tumor is suspected when it is
ulcerated or large (over 3 cm), and is easily confirmed by biopsies. The typing of
intracanalar tumors is more difficult.
In a 5-year period, an ampullary tumor was detected by ERCP in 52 patients: the tumor
was exophytic in 33 and intracanalar in 19. Adenocarcinoma was confirmed in 26 and
adenoma in 26, resulting in a 50 % ratio. Among the adenomas. 18 were fully benign
and 8 had a superficial cancer focus. Therapeutic procedures included: laser photodestruction
in 16, snare resection in 16, sphincterotomy in 47, stenting in 8, surgical bypass
in 7, cephalic duodenopancreatectomy in 16.
The 16 patients treated by laser (Nd:YAG mainly) included 8 adenomas: a complete tumor
destruction was obtained in 7 (follow up from 14 to 53 months). Adenomatous recurrence
was observed at 2 years in one patient. In 8 other patients the tumor was an adenocarcinoma;
Laser photodestruction failed to completely destroy the tumor in 1 patient (operative
control), in 7 others it was adopted as a complement to sphincteromy and stenting
in palliation, but was not found very effective. In conclusion, this procedure should
be proposed only for the destruction of sessile benign ampullary adenoma, being a
less aggressive procedure than surgical excision.
Key words:
Papilla of Vater - Tumors - Therapy - Laser treatment
