Adenomas of the Ampulla of Vater: A comparison of Outcomes of Operative and Endoscopic Resections

Abstract

There is no significant difference between endoscopic and local operative resections of benign adenomas of ampulla of Vater; recurrences are more common when two or more endoscopic resections are required for complete tumor removal. Appropriate adenomas for endoscopic resection included tumors <3.6 cm that do not extend far enough intraductally (on EUS) to preclude an endoscopic snare ampullectomy.

Endoscopic and surgical ampullectomy for non-invasive ampullary tumors: Short-term outcomes

“…Endoscopy was associated with shorter intervention (51 vs. 191 min, p < 0.001) and decreased blood loss (0 vs.100 mL, p < 0.001). Overall, surgical patients experienced more postoperative complications Comparative studies on these less invasive alternatives reported that EA was associated with lower morbidity compared to SA (7,12). The comparison with previous studies is somehow awkward since they did not focus on postoperative complications, but rather reported overall morbidity without using a validated grading system (7,12).…”

“…Overall, surgical patients experienced more postoperative complications Comparative studies on these less invasive alternatives reported that EA was associated with lower morbidity compared to SA (7,12). The comparison with previous studies is somehow awkward since they did not focus on postoperative complications, but rather reported overall morbidity without using a validated grading system (7,12). Notwithstanding, a landmark study by Ceppa et al showed an overall morbidity of 18% for EA compared to 42% for patients undergoing surgery (p = 0.006) (7); these findings are indeed consistent with the present results.…”

“…With this in mind, Figure 1 aimed to propose an algorithm to guide the decision-making for the preoperative assessment and for the treatment of ampullary neoplasms, primarily based on the evidence from the literature (3,7,8,12,15). This algorithm may be particularly pertinent to help gastroenterologists and hepatopancreatobiliary surgeons, to tailor their decision-making for the treatment of patients with noninvasive ampullary tumors.…”

“…Age < 18 years, immunosuppressive treatment and emergency surgery were considered as exclusion criteria. EA and SA were performed according to techniques described previously (7,12). Non-invasive ampullary tumor was defined as adenoma or in situ adenocarcinoma.…”

“…Indeed, less invasive techniques such as surgical ampullectomy (SA) and endoscopic ampullectomy (EA) have been acknowledged as appropriate approaches for this indication (7)(8)(9)(10)(11). While a few studies comparing SA vs. EA have been reported, the morbidity related to these techniques has not been thoroughly assessed and compared (7,12).…”