Systematic Review with Meta-analysis: Endoscopic and Surgical Resection for Ampullary Lesions

Heise, Christian; Ali, Einas Abou; Hasenclever, Dirk; Auriemma, Francesco; Gulla, Aistė; Regnér, Sara; Gaujoux, Sébastien; Hollenbach, Marcus

doi:10.1016/j.pan.2020.07.186

Cited by 5 publications

(13 citation statements)

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“…However, there has not been a robust evaluation of specific criteria for distinguishing ampullary adenomas from early AAC based on endoscopic appearances[ 10 ]. There has been controversy regarding whether tumour size correlates with the likelihood of cancer: whilst some authors have supported this assertion, several studies, including a recent meta-analysis, have found no correlation[ 6 , 12 , 37 , 38 ]. ERCP is useful for evaluating intraductal extension: it has been found to have a sensitivity of 83% and a specificity of 93% for detecting intraductal extension relative to post-operative histology, which was comparable to EUS[ 34 ].…”

Section: Pre-operative Evaluationmentioning

confidence: 99%

“…Studies of SA have all been observational and heterogenous in their methodologies and findings, resulting in a deficient evidence base[ 38 ]. Furthermore, SA has been an uncommon treatment for a rare tumour, and has therefore attracted relatively little attention.…”

Section: Indicationsmentioning

confidence: 99%

“…A few authors have proposed maximum sizes for SA of 2.5-4 cm, on the justification that larger adenomas may be more likely to contain cancer[ 20 , 22 , 51 ]. However, most authors have not reported an upper size threshold; this position is supported by the significant amount of data finding no such correlation between size and malignant potential[ 6 , 12 , 37 , 38 ]. Accordingly, SA has been successfully performed for carefully selected large adenomas (Figure 1 ).…”

Section: Indicationsmentioning

confidence: 99%

“…No randomized controlled trial (RCT) has been conducted to compare SA to EP or PD for any indication[ 38 ]. The evidence has been entirely observational; most studies have been retrospective single-centre case series or cohort studies.…”

Section: Clinical Outcomesmentioning

confidence: 99%

“…A recent systematic review and meta-analysis by Heise et al [ 38 ] reported a pooled complete excision (R0) rate for SA of 96.4%, from 10 studies including adenomas and AACs. However, some small studies which were not included have reported less favourable results.…”

Section: Clinical Outcomesmentioning

confidence: 99%

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Surgical ampullectomy: A comprehensive review

Scroggie¹,

Mavroeidis²

2021

WJGS

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Tumours of the ampulla of Vater are relatively uncommon lesions of the digestive system. They are typically diagnosed at an earlier stage than other types of tumours in this region, due to their tendency to invoke symptoms by obstructing the bile duct or pancreatic duct. Consequently, many are potentially curable by excision. Surgical ampullectomy (SA) (or transduodenal ampullectomy) for an ampullary tumour was first described in 1899, but was soon surpassed by pancreatoduodenectomy (PD), which offered a more extensive resection resulting in a lower risk of recurrence. Ongoing innovation in endoscopic techniques over recent decades has led to the popularization of endoscopic papillectomy (EP), particularly for adenomas and even early cancers. The vast majority of resectable ampullary tumours are now treated using either PD or EP. However, SA continues to play a role in specific circumstances. Many authors have suggested specific indications for SA based on their own data, practices, or interpretations of the literature. However, certain issues have attracted controversy, such as its use for early ampullary cancers. Consequently, there has been a lack of clarity regarding indications for SA, and no evidence-based consensus guidelines have been produced. All studies reporting SA have employed observational designs, and have been heterogeneous in their methodologies. Accordingly, characteristics of patients and their tumours have differed substantially across treatment groups. Therefore, meaningful comparisons of clinical outcomes between SA, PD and EP have been elusive. Nevertheless, it appears that suitably selected cases of ampullary tumours subjected to SA may benefit from favourable peri-operative and long-term outcomes with very low mortality and significantly long survival, hence its role in this setting warrants further clarification, while it can also be useful in the management of specific benign entities. Whilst the commissioning of a randomised controlled trial seems unlikely, well-designed observational studies incorporating adjustments for confounding variables may become the best available comparative evidence for SA, potentially informing the eventual development of consensus guidelines. In this comprehensive review, we explore the role of SA in the modern management of ampullary lesions.

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Section: Pre-operative Evaluationmentioning

confidence: 99%

Section: Indicationsmentioning

confidence: 99%

Section: Indicationsmentioning

confidence: 99%

Section: Clinical Outcomesmentioning

confidence: 99%

Section: Clinical Outcomesmentioning

confidence: 99%

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Surgical ampullectomy: A comprehensive review

Scroggie¹,

Mavroeidis²

2021

WJGS

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Effect of prophylactic endoscopic clipping for prevention of delayed bleeding after endoscopic papillectomy for ampullary neoplasm: a multicenter randomized trial

et al. 2022

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Background Endoscopic clip placement is technically challenging using a duodenoscope, limiting their application for treatment of bleeding after endoscopic papillectomy. This study evaluated the efficacy of newly designed clips to prevent bleeding after endoscopic papillectomy. Methods Patients (n = 80) with suspected benign adenomas on the major papilla who were scheduled for endoscopic papillectomy with or without clipping were randomized. A new duodenoscope-compatible clip capable of being rotated, reopened, and repeatedly repositioned was used. The primary end point was incidence of delayed bleeding. Results The clipping procedure was successful in all patients. The incidence of delayed bleeding was nonsignificantly higher in the no-clipping group than in the clipping group (31.6 % [95 % confidence interval (CI) 19.1–47.5] vs. 15.0 % [95 %CI 7.1–29.1]). The incidence of post-endoscopic retrograde cholangiopancreatography pancreatitis did not differ significantly between the groups (clipping vs. no-clipping: 17.5 % [95 %CI 8.7–31.9] vs. 5.3 % [95 %CI 1.5–17.3]), and all cases were mild. Conclusions Placement of the newly designed rotatable clip was technically feasible and tended to have a protective effect by preventing delayed bleeding after endoscopic papillectomy, although statistical significance was not reached.

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Efficacy and safety of endoscopic papillectomy: a multicenter, retrospective, cohort study on 227 patients

Gondran¹,

Musquer²,

Pérez-Cuadrado-Robles

et al. 2022

Therap Adv Gastroenterol

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Background: Endoscopic papillectomy is a minimally invasive treatment for benign tumors of the ampulla of Vater or early ampullary carcinoma. However, reported recurrence rates are significant and risk factors for recurrence are unclear. Objective: The aims of this study were to evaluate the efficacy and safety of endoscopic papillectomy and to identify risk factors for recurrence and adverse events. Methods: All patients who underwent endoscopic papillectomy at five tertiary referral centers between January 2008 and December 2018 were included. Recurrence was defined as the detection of residue on one of the follow-up endoscopies. Treatment success was defined as the absence of tumor residue on the last follow-up endoscopy. Results: A total of 227 patients were included. The resections were en bloc in 64.8% of cases. The mean lesion size was 20 mm (range: 3–80) with lateral extension in 23.3% of cases. R0 resection was achieved in 45.3% of cases. The recurrence rate was 30.6%, and 60.7% of recurrences were successfully treated with additional endoscopic treatment. Finally, treatment success was achieved in 82.8% of patients with a median follow-up time of 22.3 months. R1 resection, intraductal invasion, and tumor size > 2 cm were associated with local recurrence. Adverse events occurred in 36.6% of patients and included pancreatitis (17.6%), post-procedural hemorrhage (11.0%), perforation (5.2%), and biliary stenosis (2.6%). The mortality rate was 0.9%. Conclusion: Endoscopic papillectomy is an effective and relatively well-tolerated treatment for localized ampullary tumors. In this series, R1 resection, intraductal invasion, and lesion size > 2 cm were associated with local recurrence.

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Systematic Review with Meta-analysis: Endoscopic and Surgical Resection for Ampullary Lesions

Cited by 5 publications

References 0 publications

Surgical ampullectomy: A comprehensive review

Surgical ampullectomy: A comprehensive review

Effect of prophylactic endoscopic clipping for prevention of delayed bleeding after endoscopic papillectomy for ampullary neoplasm: a multicenter randomized trial

Efficacy and safety of endoscopic papillectomy: a multicenter, retrospective, cohort study on 227 patients

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