Argonoplasmic Coagulation in Complex Treatment of Enlarged Papillary Adenoma

Papillary adenoma of enlarged duodenal papilla (EDP) is referred to pre-cancer diseases & the optimum method of their removal is not yet determined. Endoscopic methods include papillaectomy using polypectomic loop, laser coagulation, monopolar & bipolar coagulation, argonoplasmic coagulation (APC). Results of APC usage on 14 patients were analyzed. At the moment of study 7 patients had obstructive jaundice, 7 patients had transitory obstructive jaundice in past history. Endoscopic papillosphincterotomy (EPST) was conducted on all the patients prior to APC. Obstructive jaundice was cured with all the patients. Two patients were subjected to electroexcision of malignant tissue of EDP with polypectomic loop, three patients underwent surgical diathermy. In one case the main pancreatic duct was replaced with 5 french Wilson-COOK stent. APC was made with the help of ERBE APC 300 ICC 300 apparatus (Germany) in SPRAY mode, 60 W, with the gas flow rate 0,5-2 l/min. APC was continued until the visual destruction of malignant tissues. In one case edematic pancreatitis was developed and it was conservatively treated. Recurrent adenoma was observed in two patients: in 1 case argonoplasmic coagulation was repeated. In the other case pancreaticoduodenal resection was made. The obtained results testify to the efficiency of argonoplasmic coagulation in the complex treatment of EDP. In case of recurrent EDP with malignant symptoms timely laparotomic resection is required.