A novel approach emphasizing preoperative margin enhancement of tumor of the major duodenal papilla with narrow-band imaging in comparison to indigo carmine chromoendoscopy (with videos)

BackgroundEndoscopic papillectomy (EP) has been recognized as a safe and reliable treatment for tumor of the duodenal papilla. For complete resection, precise assessment of not only the intraductal extent but also the lateral margins of the tumor is mandatory before resection.ObjectiveOur purpose was to prospectively assess the enhancement of the lateral margins of tumor of the duodenal papilla for the treatment of EP by comparing narrow-band imaging (NBI) and indigo carmine (IC) chromoendoscopy.DesignProspective study.SettingThis procedure was performed in Tokyo Medical University Hospital.PatientsFourteen consecutive cases of tumors of the major duodenal papilla.InterventionAll patients underwent EP after evaluation by NBI and IC.Main Outcome MeasurementHistologic evaluation of diagnosis of NBI and IC by comparison with en bloc tissue.ResultsIn all lesions, either IC or NBI were superior to conventional white-light imaging except in 1 IC case. The ability of NBI observation to emphasize the tumor margin was statistically significantly better than IC observation (P < .05). The en bloc EP was endoscopically successful in all cases, without fatal adverse events. En bloc tissue revealed 13 adenomas and 1 adenoma with focal adenocarcinoma. There was no residual adenoma in lateral margin specimens, either endoscopically or histologically.LimitationsThe lesions resected were all relatively small. This was not a blinded randomized study.ConclusionThis study demonstrated the feasibility and a certain degree of efficacy of NBI for enhancement of the tumor margin of duodenal papilla. Further blinded randomized studies involving large duodenal papillary tumors are required.