Endoscopic Resection of Ampullary Adenomas: Complications and Outcomes

Patel, R.; Davitte, Jonathan; Varadarajulu, Shyam; Wilcox, C. Mel

doi:10.1007/s10620-011-1826-4

Cited by 50 publications

(35 citation statements)

References 25 publications

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“…10-12 Patel reported a recurrence rate of 16% after endoscopic ampullectomy over a mean follow-up period of only 17.2 months. 13 Only 9 of the 38 cases in this series were associated with FAP. In another series of 193 patients who underwent endoscopic ampullectomy, most had sporadic disease.…”

Section: Discussionmentioning

confidence: 69%

Recurrences are common after endoscopic ampullectomy for adenoma in the familial adenomatous polyposis (FAP) syndrome

Jang

Zukerberg

et al. 2014

Surg Endosc

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Background Endoscopic ampullectomy is increasingly performed in patients with FAP (familial adenomatous polyposis)-associated ampullary adenomas. We sought to define the procedure-associated morbidities and long-term outcomes. Methods We performed a retrospective chart review of patients with FAP who underwent endoscopic ampullectomy at two tertiary institutions between 1999 and 2010. The severity of duodenal polyposis was classified according to Spigelman's classification. Results Of 26 FAP patients who underwent endoscopic ampullectomy, 21 arose in the setting of Spigelman's stage II duodenal polyposis. Adverse events associated with endoscopic ampullectomy included acute pancreatitis (19.2%), abdominal pain (7.6%), and bleeding (3.8%). The mean resected adenoma size was 0.99 ± 0.34 cm. Three adenomas (12.0%) contained foci of high-grade dysplasia. Follow-up data were available for 24 patients. The mean follow-up duration was 84.5 ± 36.2 months. Adenoma recurrence was observed in 14 patients (58.3%, 14/24) at a mean of 38.3 months after initial ampullectomy. Adenomas ≥ 10 mm recurred more frequently than smaller adenomas (76.9% vs. 36.4%, p=0.002). Positive margins were not associated with higher recurrence rates. No cancers were observed during long-term follow-up. Three patients underwent a Whipple procedure, but none was performed due to a recurrent ampullary adenoma. Conclusions Endoscopic ampullectomy in FAP can be performed safely. Because ampullary adenomas frequently recur after endoscopic ampullectomy, close surveillance is essential. Smaller tumors are less likely to recur, suggesting a benefit for early recognition of these lesions.

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Section: Discussionmentioning

confidence: 69%

Recurrences are common after endoscopic ampullectomy for adenoma in the familial adenomatous polyposis (FAP) syndrome

Jang

Zukerberg

et al. 2014

Surg Endosc

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“…Endoscopic papillectomy was performed in pathologic confirmed ampullary adenoma by endoscopic biopsy or cases of highly suspicious ampullary tumors by gross endoscopic examination even if biopsies were not confirmative. Although small (<25 mm), obviously benign adenoma could be resected without extensive prepapillectomy work up,8 we performed endoscopic ultrasound (EUS) or other imaging work up (such as computed tomography [CT] or magnetic resonance imaging [MRI]) in all patients before endoscopic papillectomy to assess the extent of the lesion, and the presence of lymph node metastasis. When intraductal extension was suspected, endoscopic retrograde cholangiopancreatography (ERCP) was performed at the time of planned papillectomy.…”

Section: Methodsmentioning

confidence: 99%

Prophylactic Pancreatic Stent Placement for Endoscopic Duodenal Ampullectomy: A Single-Center Retrospective Study

Chang¹,

Ye²,

Yun³

et al. 2014

Gut Liver

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Background/AimsWe investigated the efficacy of prophylactic pancreatic stent placement for preventing postprocedure pancreatitis in patients undergoing endoscopic papillectomy.MethodsThis retrospective study included 82 consecutive patients who underwent endoscopic papillectomy for benign ampullary neoplasm at Samsung Medical Center between August 2002 and June 2011. The patients were subdivided into two groups, namely, those who received prophylactic pancreatic stent placement and those who did not. Patient demographics, baseline blood test, tumor characteristics, and endoscopic treatment data were collected. The primary endpoint was postprocedure pancreatitis.ResultsThere was no difference in the development of postprocedure pancreatitis between the stent group and the no stent group (6/54, 10.5% and 2/28, 7.14%, respectively; p=1.00). At baseline, there were no significant differences between the two groups in terms of their risk factors for pancreatitis except pancreatic duct dye injection. The stent group was more likely to have dye injection than the nonstent group (100% vs 42.8%, p<0.001). However, in a logistic regression analysis, no significant difference was observed in the risk factors for pancreatitis including dye injection.ConclusionsOur data suggest that routine prophylactic pancreatic duct stent placement in all patients undergoing endoscopic papillectomy may not be necessary and that large-scale prospective studies are required to identify the subgroup of patients who would benefit.

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“…Complications after endoscopic ampullectomy include pancreatitis (0%-25%), bleeding (0%-25%), perforation (0%-4%), cholangitis (0%-2%), and papillary stenosis (0%-8%) (4,6,9,11,13,44,(63)(64)(65) (Table I). The most serious complications are perforation, pancreatitis and delayed bleeding (44).…”

Section: Complications Of Ampullectomymentioning

confidence: 99%

Endoscopic ampullectomy: A technical review

Espinel¹,

Pinedo²,

Ojeda³

et al. 2015

Rev Esp Enferm Dig

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Background and aim:This article provides a practical review to undertaking safe endoscopic ampullectomy and highlights some of the common difficulties with this technique as well as offering strategies to deal with these challenges.Methods: We conducted a review of studies regarding endoscopic ampullectomy for ampullary neoplasms with special focus on techniques.Results: Accurate preoperative diagnosis and staging of ampullary tumors is imperative for predicting prognosis and determining the most appropriate therapeutic approach. The optimal technique for endoscopic ampullectomy is dependent on the lesions size. En bloc resection is recommended for lesions confined to the papilla. There is no significant evidence to support the submucosal injection before ampullectomy. There is no consensus regarding the optimal current and power output for endoscopic ampulectomy. The benefits of a thermal adjunctive therapy remain controversial. A prophylactic pancreatic stent reduces the incidence and severity of pancreatitis post-ampullectomy.Conclusions: Endoscopic ampullectomy is a safe and efficacious therapeutic procedure for papillary adenomas in experienced endoscopist and it can avoid the need for surgical intervention.

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Endoscopic Resection of Ampullary Adenomas: Complications and Outcomes

Abstract: Endoscopic ampullectomy is a safe and effective treatment for benign ampullary neoplasms and should become the treatment of choice rather than surgical therapy.

Cited by 50 publications

References 25 publications

Recurrences are common after endoscopic ampullectomy for adenoma in the familial adenomatous polyposis (FAP) syndrome

Recurrences are common after endoscopic ampullectomy for adenoma in the familial adenomatous polyposis (FAP) syndrome

Prophylactic Pancreatic Stent Placement for Endoscopic Duodenal Ampullectomy: A Single-Center Retrospective Study

Endoscopic ampullectomy: A technical review

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