title: Success and complications of endoscopic removal of giant duodenal and ampullary polyps: a comparative series.
abstract: BACKGROUND
  Increasing reports suggest that endoscopic removal of benign ampullary and duodenal polyps is safe and frequently definitive; however, most reported polyps have been small in size (<3 cm). We have developed experience with endoscopic removal of increasingly large and complex polyps.
  
  
  METHODS
  Fifty-one cases of endoscopic removal were attempted and grouped according to size: group A (n = 22) polyps 1 to 3 cm and group B (n = 29) polyps 3 cm or larger, including 7 cases larger than 5 cm. When the ampulla was involved, biductal sphincterotomy and prophylactic pancreatic duct stent placement was performed first, followed by saline solution-assisted piecemeal polypectomy, argon plasma coagulation, selective endoclip placement, and recovery of all polyp fragments.
  
  
  METHODS
  Endoscopic removal of duodenal and ampullary adenomas.
  
  
  RESULTS
  The outcomes of small and large adenoma removal include mean number of endoscopic retrograde cholangiopancreatographies required for complete removal (2.09 vs 2.56, P = .392), number of complications (4.5% vs 13.9%, P = .375), discovery of unsuspected cancer (0% vs 10.3%, P = .242), and final definitive resolution (100% vs 86.2%, P = .124). Complete removal was achieved in 92.2% of all patients.
  
  
  CONCLUSIONS
  This was a single center retrospective study.
  
  
  CONCLUSIONS
  Large (>/=3 cm) ampullary and duodenal polyps comprised 56.9% of our endoscopically treated cases and present special challenges to definitive endoscopic removal. Successful removal of even very large sessile lesions is possible with minimal increase in risk.
authors.affiliation: Maine Medical Center, Portland, Maine, USA.
authors.forename: Sheila L
authors.initials: SL
authors.lastname: Eswaran
authors.forename: Michael
authors.initials: M
authors.lastname: Sanders
authors.forename: Kirk P
authors.initials: KP
authors.lastname: Bernadino
authors.forename: Asif
authors.initials: A
authors.lastname: Ansari
authors.forename: Christopher
authors.initials: C
authors.lastname: Lawrence
authors.forename: Andreas
authors.initials: A
authors.lastname: Stefan
authors.forename: Anthony
authors.initials: A
authors.lastname: Mattia
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Howell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D003138:Common Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D003937:Diagnosis, Differential; D004379:Duodenal Neoplasms / Q000473:pathology / Q000601:surgery*; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011127:Polyps / Q000473:pathology / Q000601:surgery*; D012720:Severity of Illness Index; D016896:Treatment Outcome