十二指腸乳頭部および副乳頭部病変

The Lesions of Major and Minor Duodenal Papilla

要旨●十二指腸乳頭部腫瘍は上部消化管スクリーニング検査で唯一発見可能な膵胆道癌である．さらに，乳頭部腫瘍の一部は内視鏡治療の対象となるため早期発見する意義は大きい．直視鏡によるスクリーニング検査では，乳頭の顆粒状隆起，口側隆起腫大，開口部周囲の粘膜不整に注意する必要がある．また，乳頭部はNETの好発部位でもある．乳頭部・副乳頭部NETは，他部位に比べるとリンパ節転移が高率であり，腺腫・癌と同様，スクリーニング検査で早期発見する意義は大きい．

　Of all pancreaticobiliary cancers, the tumor of the major and minor duodenal papilla is the only cancer that can be detected via routine upper gastrointestinal endoscopy. As part of the ampullary tumor is subject to endoscopic resection, early detection is imperative. Additionally, in screening using forward-viewing endoscopy, it is essential to focus on granular changes in the papilla, enlargement of the longitudinal fold, and mucosal irregularity around the papillary orifice. Furthermore, both the major and minor papilla are the preferred sites for NETs（neuroendocrine tumors）. As NET exhibits a high rate of lymph node metastasis compared with other sites ; it is significant for early detection by screening examination like adenoma and cancer.