Endoscopic Resection of Nonadenomatous Ampullary Neoplasms

Abstract

The safety and effectiveness of endoscopic management of ampullary adenomas is well known. However, data on the endoscopic treatment and long-term outcome of nonadenomatous ampullary neoplasms are lacking. We describe our experience with the endoscopic management and the follow-up of 4 patients with nonadenomatous ampullary neoplasms viz, ampullary carcinoid, gangliocytic paraganglioma, ampullary hamartoma in patients with Peutz-Jegher syndrome and Cowdens syndrome.

Complete Resection of Ampullary Paragangliomas Confined to the Submucosa on Endoscopic Ultrasound May Be Best Achieved by Radical Surgical Resection

“…Some have advocated local endoscopic or surgical resection, especially when EUS imaging shows the lesion to be confined to the submucosa [10]. Out of 25 ampullary paragangliomas previously reported in the literature [10,11], nine had evidence of lymph node and/or distant metastases [1,2,3,4,5,6,7,8,9]. There have been no reports of disease recurrence in patients initially treated by pancreaticoduodenectomy, even when simultaneous lymph node invasion was present [1, 3, 5, 6].…”

Gangliocytic Paraganglioma of the Minor Papilla of the Duodenum

“…It rarely develops in other organs, including the esophagus, mediastinum (6), thymus (7), lung (8), and ovary (9). According to a search of the PubMed database, 45 cases of the duodenal GP have been reported during the last decade (2007-2016) (Table 2) (2,3,10-48). This tumor frequently develops in middle-aged and elderly individuals (mean, 51.2 years; range, 16-92 years) and predominantly affects men (27 men vs. 18 women).…”

Minute ampullary carcinoid tumor with lymph node metastases: a case report and review of literature

“…On the other hand, the tumors that were less than 20 mm in diameter have recently been managed by local excision [ 7 , 9 ], and some cases of endoscopic ampullectomy have also been reported [ 1 - 3 ]. Although less radical treatment strategies have been investigated to reduce surgical morbidity and preserve organ function as a reasonable alternative to pancreatic resection, there is a risk of incomplete tumor removal if preoperative evaluation is not accurate.…”

“…Ampullary carcinoid is an extremely rare tumor, and approximately 105 cases have been reported in the literature so far [ 1 ]. Whipple resection is the usual surgical treatment for this disease, but less radical procedures such as local excision or endoscopic ampullectomy have recently been reported for small carcinoid tumor [ 1 - 3 ], which are generally considered to be benign. Here we report a very rare case of a minute ampullary carcinoid (7 mm in diameter) that showed regional lymph node metastases, and we review the literature with emphasis on the treatment of this disease.…”