Abstract
Understanding of the particular anatomy of the papillary region is indispensable in diagnosing tumors of the papilla of Vater. The tumors are mostly carcinoma or adenoma, but some are carcinoid or endcrine tumors. Opinions differ, on whether all the adenomas should be treated. However, treatments are usually indicated for the papillary adenoma accompanying familial adenomatous polyposis (FAP). Also, as the adenoma-carcinoma sequence is recognized in some adenomas excluding FAP, an increasing opinion is to positively approve treatment for all adenomas.
For diagnosing the tumor extent, not only by determination of tumor invasion of duodenal wall (Du) and pancreas (Panc), but also the evaluation of bile duct and pancreatic duct extension by using EUS and IDUS is required. It is controversial whether we can reveal sphincter of Oddi, and whether we can diagnose early-stage cancer.
Although the treatment is basically a surgical operation, endoscopic papillectomy has been drawing attention all over the world, While it is agreed on its indication for adenomas without extension into bile duct or pancreatic duct, opinions vary on its extended application to early-stage cancer.
The problems are that accurate preoperative diagnosis of early-stage cancer is at present difficult, and the frequency of lymph node metastasis of early-stage cancer lodged at the sphincter of Oddi has not been clearly known. These are yet to be solved. And the management of complications post endoscopic papillectomy and also long-term disease course is a topic for further research.
