Endoscopic ampullectomy for papillary tumors: A single-center experience
Introduction: Ampullary adenoma is an uncommon, pre-cancerous lesion arising from the duodenal papilla. Endoscopic ampullectomy may be proposed in patients with smaller lesions without invasive carcinoma. There are aspects on the diagnosis and the management of ampullary tumors which are not well established. Objetive: To evaluate the efficacy and safety of endoscopic ampullectomy for assessing the correct diagnosis and treatment of ampullary tumors. Patients and methods: All ampullary tumors with lesion size less than 3 cm, without macroscopic features of malignancy, identified from May 2000 to December 2014, were included in the study. Thirteen endoscopic ampullectomies were undertaken in 9 males (69.2%) and 4 females (30.7%) with a mean age of 71. No endoscopic ultrasound was performed prior to the endoscopic resection. Clinical history, imaging assessment, preoperative histology, complications and followup were reviewed. Results: The resection was achieved in one piece for 12 patients (92.3%). A pancreatic stent was inserted in 10 patients. There was no mortality but three complications occurred: 1 acute pancreatitis (7.6%), 2 post ampullectomy bleeding (15.3%). The definitive histological results included: adenoma with low-grade dysplasia (5); adenoma with high-grade dysplasia or in situ carcinoma (2); and invasive carcinoma (6). The resection was sufficient and complete in 53.8%, 6 patients required additional surgery. The median follow-up was 25.8 months. Conclusion: Endoscopic ampullectomy is an effective procedure for assessing the diagnosis of ampullary neoplasms, and for subsequent therapeutic management in selected patients. Bleeding and pancreatitis are the most common complications.Copyright © 2015 Journal of Interventional Gastroenterology.
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