Review Article The Korean Journal of Pancreas and Biliary Tract 2014;19: pissn eissn 22

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1 Review Article The Korean Journal of Pancreas and Biliary Tract 2014;19: pissn eissn 유두부종양의진단과치료에서내시경의역할 연세대학교의과대학내과학교실소화기내과, 소화기병연구소 이희승ㆍ방승민 Hee Seung Lee, Seungmin Bang Division of Gastroenterology, Department of Internal Medicine and Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea Tumors of the major duodenal papilla, also known as ampullary tumor, are rare with an approximate 5% incidence of all gastrointestinal neoplasm. These tumors seem to be detected more frequently with increasing performance of upper endoscopic examination and endoscopic retrograde cholangiopancreatography (ERCP). Adenoma, most common benign disease of ampullary tumor, is very important because of its potential to undergo malignant transformation to ampullary cancer. Especially, endoscopic ultrasound or transpapillary intraductal ultrasonography can provide more detailed and accurate information on the extent of ampullary tumors and proper treatment should be done after diagnosis. Considering perioperative morbidity and mortality of surgical resection, endoscopic papillectomy is regarded as a curative treatment of ampullary adenoma. However, the indication of the procedure is very strict and there are various complications related to the procedure. Therefore, it is important to understand the role of endoscopy in diagnosis and treatment of ampullary tumor. In this review, the diagnostic role of endoscopy for ampullary tumor and the treatment method of endoscopic papillectomy will be discussed. Keywords: Ampullary tumor, Ampullary adenoma, Ampullary cancer, Endoscopic papillectomy Received May. 7, 2014 Revised Jun. 3, 2014 Accepted Jun. 4, 2014 Corresponding author : Seungmin Bang Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul , Korea Tel Fax ; bang7028@yuhs.ac This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( creativecommons.org / licenses/by-nc/3.0/ ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 서론 (ampulla of Vater). 1,2 5%,, %. 3-5,,,,.,. Copyright 2014 by Korean Pancreatobiliary Association 121

십이지장유두부종양의분류 (adenoma), (adenocarcinoma),

adenoma), (villous adenoma), (tubular adenoma).

Endoscopic appearance of various ampullary tumors.

(C) Separate orifice of bile duct and pancreatic

2 십이지장유두부종양의분류 (adenoma), (adenocarcinoma), (lymphoma), (neuroendocrine tumor), (lipoma), (fibroma), (harmatoma). (adenoma), (adenocarcinoma), (tubulovillous adenoma), (villous adenoma), (tubular adenoma) (sporadic) (Familial adenomatous polyposis, FAP) %, %. 4, 30%,,. 4,11-14 십이지장유두부종양의내시경을이용한진단,,.. A B C D E F Fig. 1. Endoscopic appearance of various ampullary tumors. (A) Ampullary adenoma, (B) choledochocele. (C) Separate orifice of bile duct and pancreatic duct. (D) Ampullary cancer. (E) Ampullary cancer and (F) unexposed type of ampullary cancer

(D) Common bile duct and main pancreatic duct invasion revealed by IDUS.

3 Hee Seung Lee, et al. A B C D Fig. 2. The role of Endoscopic ultrasound (EUS) and IDUS for ampullary tumor. (A) Endoscopic appearance of ampullary cancer. (B, C) Red arrow; Distal common bile duct invasion of tumor on EUS. (D) Common bile duct and main pancreatic duct invasion revealed by IDUS.. 15,, (Fig. 1). 1. 내시경육안소견과조직생검 (lobular) (pine-cone) %, 내시경초음파및관강내세경초음파.,,. 18 T 60-80% CT, MRI. 19,20 IDUS, (20-30 MHz). T stage (Fig. 2).,. 3. 내시경적역행성담췌관조영술

A B C D E F Fig. 3. Endoscopic papillectomy.

(B) Normal appearance of common bile duct and

(D, E) Selective cannulation and guidewire

(F) Placement of plastic stent in main pancreatic

4 A B C D E F Fig. 3. Endoscopic papillectomy. (A) 2 cm sized flat adenoma on ampulla of Vater. (B) Normal appearance of common bile duct and main pancreatic duct on endoscopic retrograde cholangiopancreatography (ERCP). (C) Endoscopic snaring of ampullary mass. (D, E) Selective cannulation and guidewire insertion into main pancreatic duct. (F) Placement of plastic stent in main pancreatic duct. 십이지장유두부종양의내시경치료 1. 내시경치료의적응증 1983 Suzuki ,, Cheng ) cm, 2) -,,,, 3) 6 4) (IDUS). 16,24,26,28.,.. 2. 내시경유두절제술술기 (Fig. 3).,,,

5 Hee Seung Lee, et al.. 점막하주사 (submucosal injection), (1:10,000-20,000).. 27,,. 24,29,,. 28,30. 올가미를이용한종양포획및절제 (snaring and endoscopic resection) snare...,.,,,., 16,30,31. 절제된종양조직회수및절제술후처지 (tissue retrieval and postprocedure management).,,,,,.,..,.,.,, Nd-YAG,. 32, 33,. 췌관스텐트및담관스텐트삽입 (pancreatic and/or biliary stent placement). 26,27,33,,,., Harewood 34.,, 125

6 .,. 16,24,27,29 십이지장유두부종양의내시경치료성적 90%, 5 80%. 16,24,26, %,. 70%. 내시경치료의합병증,,,.. 32 (0.09%), ,. CT... 시술후추적관찰. 26%. 27,,,,. 3, 1., 3. 결론,...,. 국문색인 : 십이지장유두부종양, 십이지장유두부선종, 십이지장유두부선암, 내시경유두절제술 Conflicts of Interest The author has no conflicts to disclose. REFERENCES 1. Avisse C, Flament JB, Delattre JF. Ampulla of Vater. Anatomic, embryologic, and surgical aspects. Surg Clin North Am 2000;80: Keddie NC, Taylor AW, Sykes PA. The termination of the common bile duct. Br J Surg 1974;61: Grobmyer SR, Stasik CN, Draganov P, et al. Contemporary results with 126

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