I had a tubular adenoma diagnosed early 2012 in my duodenum. An doctor tried removing it several times endoscopically. The last biopsy late last Oct. revealed a villous adenoma with high grade displaysia. He tried to remove it one more time, but was unsuccessful due to scar tissue. It is extremely small, not even measured in centimeters. I was referred to a surgeon for the whipple. I have since gotten a couple more opinions. Two hospitals believe it is high grade displaysia, one saying there were no signs of high grade displaysia. The one reporting no signs of high grade displaysia s a leading cancer hospital. They want to take a wait and see approach since I developed acute pancreatitis as a result of my ERCP's. The lastest opinion I received suggested a laproscopic ampullectomy. No other doctors even discussed this option with me. What do you think? As it stands now, I am scheduled to go back to the cancer hospital mid- Feb. for another biopsy.
Well, without knowing the relevant clinical details or a detailed clinical evaluation it would be difficult to comment specifically on the situation. If the biopsy is suspicious of cancer, a surgery would be required; and if a laproscopic surgery has not been successful, an open surgery is usually advised. Well, if I were in your situation with 2/3 pathologists describing the biopsy report as dysplasia, I would rather go ahead with the surgery rather than taking the risk of not having one just in case it turns out to be benign.
I am not sure how far would a laproscopic ampulectomy be successful in removing the adenoma with adequate margins; while if it is an option worth considering, I would suggest getting a second opinion from another gastroenterologist/ gastrosurgeon, preferably at a university/ teaching hospital for a detailed evaluation and suggestion of an appropriate management plan.
Hope this is helpful.
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