Endoscopic Diagnosis of Lesions in the Papillary Region of the Duodenum M. Kobayashi 1 , T. Okabe 1 , T. Taguchi 1 , Y. Ota 1 , K. Tsuneoka 1 13 rd. Dept. of Internal Medicine, Nippon Medical School pp.1467-1472
Published Date 1972/11/25
DOI https://doi.org/10.11477/mf.1403109019
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 Progress in duodenofiberscopic examination has not only made it easy to observe the region of the papilla of Vater but also made it possible to arrive at comprehensive diagnosis including biopsy and retrograde visualization of the pancreatic and biliary ducts. At present there still remains some confusion regarding the appropriate terms of this region.

Anatomy has not too standardized name for it, and clinically a common expression is employed. Endoscopic examination, depending solely on observation with the naked eye, needs a standardized, clear-cut nomenclature for it, as it is necessary to accurately describe findings observed. In this paper are used such names as the longitudinal fold, papilla and frenulum, and the longitudinal fold and papilla are collectively called as the region of the papilla of Vater.

 Cancer in the papillary region is the most important lesion in this area. If radical operation be carried out at a proper time, prognosis would be much improved. As it is a lesion that permits easy access to endoscopy, correct diagnosis of cancer in this region is all the more important. Endoscopic findings of it are expressed more or less in such terms as swelling of the longitudinal fold, edematous protrusion of the papilla, its unevess, erosion, bleeding or tendency to it. Co-employement of biopsy and pancreatocholedochography is essential.

 Papillitis is known as a benign stricture at the distal end of the common bile duct, but the site of the lesion belongs to the Vaterian system, and it is seen as change in the papillary region. Since it is a submucosal change, however, diagnosis is not always easy. Differention from cancer calls for more detailed investigation.

 Choledocholithiasis is often accompanied with icterus, and it becomes an objective of duodenal examination, retrograde choledochography being the most effective method of diagnosis for it. Changes in the papilla are often slight, while protrusion of the longitudinal fold is mostly manifest.

 Endoscopically papillary diskinesia is twofold: either the orifice remains open or its site becomes obscure owing to decreased function of the sphincter.

 In parapapillary diverticulum we were unable to find out any change of the papillary region effected by it.

 Together with endoscopy of the papillary region, pancreatocholedochography is most effective in the diagnosis of lesions in this area and in biliary and pancreatic ducts. Several cases are illustrated in this paper.

Copyright © 1972, Igaku-Shoin Ltd. All rights reserved.


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