Clinical efficacy analysis of endoscopic resection of large diameter duodenal papilla tumors

Objective To explore the feasibility and clinical value of endoscopic resection of duodenal papilla tumors with a maximum diameter greater than 3 cm.

Methods  A retrospective analysis was conducted on the clinical data of all 12 patients who underwent endoscopic resection of duodenal papilla tumors at the Endoscopy Center of Zhongshan Hospital(Xuhui Hospital), Fudan University and Rongcheng Hospital of Traditional Chinese Medicine from September 2017 to May 2023. The size of the tumors all exceeded 3 cm.

Results  All 12 patients successfully completed the surgery, with a complete resection rate of 91.7%(11/12) and an en-bloc resection rate of 91.7%(11/12). One patient experienced delayed bleeding due to unclosed wound during surgery and received endoscopic hemostasis; 11 cases underwent partial wound closure surgery with pancreatic and biliary stent placement, without perforation or postoperative stenosis. Among them, 2 cases (18.2%) experienced delayed bleeding and received endoscopic hemostasis treatment. After surgery, one case (8.3%) experienced nausea, vomiting, upper abdominal discomfort, and elevated blood amylase levels, which were later treated conservatively. During the follow-up period of 30.5(1.0～69.0) months , one patient experienced recurrence and underwent surgical resection.

Conclusions  Endoscopic resection of duodenal papilla tumors can treat large diameter duodenal papilla tumors exceeding 3 cm, but postoperative complications may occur and require special attention. Postoperative placement of pancreatic and biliary stents and wound closure may reduce the incidence of complications.