Results of pancreatic duct labeling in the treatment of patients with adenomas of the major duodenal papilla types I and II

Objective of the study. To evaluate the advantages of preliminary pancreatic duct marking before endoscopic removal of types I and II duodenal papilla adenomas for subsequent stenting. Material and methods. Between 2023 and 2025, 15 patients with types I and II duodenal papilla adenomas were surgically treated at the A.V. Vishnevsky Surgery Center. In all cases, the pancreatic duct was marked with indigocarmine before endoscopic removal of the tumor to improve visualization and subsequent stenting. Type I adenomas were detected in eight patients, while type II adenomas were detected in seven patients. The average size of type I adenomas was 15.1 mm, while for type II, it was 20.8 mm. Results. Technical success of endoscopic removal of duodenal papilla adenomas was achieved in all cases. In patients with type I adenomas, endoscopic removal was performed using papillary resection, while for type II adenomas, papillary resection was supplemented by duodenal mucosal resection. In thirteen cases, the pancreatic duct orifice was clearly visualized after tumor removal, allowing for successful stenting. In two cases, severe bleeding hindered visualization of the orifice; however, duct stenting was also successful after electrocoagulation. Conclusion. Preliminary marking of the pancreatic duct with indigocarmine before endoscopic removal of adenomas of the major duodenal papilla ensures clear visualization of the duct orifice after resection, reduces the number of attempts to locate the orifice, and improves the effectiveness of subsequent stenting. Despite positive results, data on the use of pancreatic duct marking are based primarily on limited case series. Large prospective studies analyzing short- and long-term outcomes are needed to comprehensively evaluate its efficacy and safety.