Figures (1)  Tables (4)

    • Figure 1. 

      The procedure of endoscopic papillectomy. Patient No. 9 underwent endoscopic submucosal dissection (ESD). The lesion's morphology was a laterally spreading tumor of the nongranular type with a flat elevation (LST-NG-F). The size of the lesion was 85 mm × 95 mm. Postoperative pathology showed moderately differentiated adenocarcinoma. This case was operated by Qide Zhang.

    • Number Gender Age Diagnosis Surgical method Past medical history
      1 Male 48 DPA EMR + ERC + ERBD None
      2 Male 53 Duodenal papillary lesion EMR + ERC + ERPD + ERBD Hypertension
      3 Male 47 Duodenal papillary lesion EMR + ERC + ERBD Hypertension
      4 Female 73 Duodenal papillary tumor ESD + ERC + ERPD Hypertension
      5 Female 74 DPA ESD + ERC + ERPD + ERBD None
      6 Male 58 Duodenal papillary lesion ESD + ERC + ERPD Hypertension
      7 Female 36 DPA EMR + ERC + ERPD Anemia
      8 Male 49 DPA ESD + ERC + ERPD Diabetes
      9 Male 71 DPA ESD + ERC + ERPD Hypertension
      10 Male 69 DPA EMR + ERC + ERPD HTN, DM, HLD, esophageal malignancy
      11 Male 59 DPA EMR + ERC + ERPD Diabetes
      12 Female 48 DPA + mucosal lesion ESD + UEMR + ERPD None
      13 Male 61 DPA ESD + ERC + ERPD Hypertension
      14 Female 34 DPA EMR + ERC + ERPD None
      15 Male 65 DPA EMR + ERC + ERPD + ERBD None
      16 Female 59 DPA EMR + ERCP + ERBD + ERPD Diabetes
      17 Female 75 DPA EMR + ERC + ERPD Hyperlipidemia
      18 Male 59 DPA EMR + ERCP + ERBD + ERPD None
      DPA, duodenal papillary adenoma; EMR, endoscopic mucosal resection; ERC, endoscopic retrograde cholangiopancreatography; ERPD, endoscopic retrograde pancreatic drainage; ERBD, endoscopic retrograde biliary drainage; ESD, endoscopic submucosal dissection; HTN, hypertension; DM, diabetes mellitus; HLD, hyperlipidemia; UEMR, underwater endoscopic mucosal resection.

      Table 1. 

      General condition.

    • Number Morphology Size (mm) EUS Pathological diagnosis Microscopic structure Margins
      1 0-Is 8 × 6 + Polypoid hyperplasia μs Mild disarray −
      2 0-Is 20 × 38 + Tubular adenoma with LGIN None −
      3 0-Is 6 × 12 + Tubular adenoma with LGIN + Local HGIN None −
      4 0-Is 25 × 45 + TSA WOS+ disarray −
      5 0-Isp 18 × 20 + Villous tubular adenoma with LGIN μs Regular −
      6 0-Is + IIa 15 × 30 − Tubular Adenoma with LGIN + Focal HGIN μv Irregular −
      7 0-Is 18 × 40 − Duodenal Adenomatous Hamartoma μs Disarray Vert. +
      8 LST-NG-F 30 × 60 − Tubular adenoma with LGIN + Local HGIN No WOS and VCL −
      9 LST-NG-F 85 × 95 + Adenocarcinoma WOS+ DL+ μs+ μv+ −
      10 0-Is 8 × 10 − Villous tubular adenoma with LGIN μs Irregular −
      11 0-Is 12 × 12 − Tubular adenoma with LGIN Adenomatous −
      12 0-IIb + IIc 20 × 25 − Tubular adenoma with LGIN WOS+ villous −
      13 SSL 12 × 20 − TSA Coarse granular −
      14 0-Is + IIa − − Tubular adenoma with LGIN Coarse granular −
      15 0-Is − + Hamartoma μs Irregular −
      16 0-Is − + Tubular adenoma with LGIN μs Irregular −
      17 0-Is 8 × 12 + Villous tubular adenoma with LGIN μs Irregular −
      18 0-Is 10 × 12 + Tubular adenoma with LGIN μs Irregular −
      EUS, endoscopic ultrasound; μs, microscopic structure; LGIN, low-grade intraepithelial neoplasia; HGIN, high-grade intraepithelial neoplasia; TSA, traditional serrated adenoma; WOS, white opaque substance; Vert., vertical margin; LST-NG-F, laterally spreading tumor of the nongranular type with a flat elevation; VCL, villous crypt length; SSL, sessile serrated lesion.

      Table 2. 

      Endoscopic morphology and pathology.

    • Number Surgical method Catheterization Bleeding Pancreatitis Other
      1 EMR + ERC + ERBD Biliary stent − − None
      2 EMR + ERC + ERPD + ERBD Both −+ − None
      3 EMR + ERC + ERBD Biliary stent − − None
      4 ESD + ERC + ERPD Pancreatic stent − − Hypertension, allergic rash
      5 ESD + ERC + ERPD + ERBD Both + − Bleeding from the posterior pharyngeal wall
      6 ESD + ERC + ERPD Pancreatic stent − − Mild infection
      7 EMR + ERC + ERPD Pancreatic stent −+ − None
      8 ESD + ERC + ERPD + PC Pancreatic stent ++ + None
      9 ESD + ERC + ERPD Pancreatic stent + − Infection
      10 EMR + ERC + ERPD Pancreatic stent − − None
      11 EMR + ERC + ERPD Pancreatic stent − − None
      12 ESD + UEMR + ERPD Pancreatic stent − − None
      13 ESD + ERC + ERPD Pancreatic stent + + None
      14 EMR + ERC + ERPD Pancreatic stent ++ + None
      15 EMR + ERC + ERPD + ERBD Both ++ − None
      16 EMR + ERCP + ERBD + ERPD Both − + None
      17 EMR + ERC + ERPD Pancreatic stent − − Mild infection
      18 EMR + ERCP + ERBD + ERPD Both −+ − Infection

      Table 3. 

      Postoperative complications.

    • Number INR NSAID PPI AMY (3 h postprocedure) SST AB Bleeding pancreatitis Endoscopic management Other management
      1 0.98 − + 60 + + − − − −
      2 0.92 − + 55 + + −+ − − −
      3 0.92 − + 58 + + − − − −
      4 1.03 − + 164 + + − − − −
      5 1.34 − + 169 + + ++ − + −
      6 1.02 − + 111 + + − − − −
      7 1.03 − + 116 + + −+ − − −
      8 1.15 − + 409 + + ++ + − −
      9 1.02 − + 117 + + + − − Gastric artery embolization
      10 1.03 − + 100 + + − − − −
      11 0.94 − + 30 + + − − − −
      12 0.92 − + 82 − − − − − −
      13 1.13 − + 618 + + + + + −
      14 1.01 − + 485 + + + + + −
      15 1.08 − + 74 + + ++ − +
      16 0.97 − + 518 + + − ++ −
      17 1.01 − + 92 + + − − −
      18 1.11 − + 124 + + −+ − −
      1 Isolated hyperamylasemia (n = 2) not classified as pancreatitis per diagnostic protocol. INR, international normalized ratio; NSAID, nonsteroidal anti-inflammatory drug; PPI, proton pump inhibitor; AMY, amylase; SST, somatostatin; AB, antibiotics.

      Table 4. 

      Auxiliary examinations and management 1.