Endoscopic resection of ampullary neoplasms: a single-center experience.
BACKGROUND
An ampullary tumor, whether malignant or not, must be completely resected. A benign adenoma has the potential for malignant transformation. Currently, endoscopic papillectomy with curative intent is increasingly performed for benign papillary tumors. This study aimed to evaluate the outcome of endoscopic papillectomy performed for ampullary tumors at a single center.


METHODS
From July 2003 to June 2008, 22 patients with a diagnosis of ampullary tumors determined by endoscopic retrograde cholangiopancreatography (ERCP) were treated using endoscopic resection of the tumors. Endoscopic resection was performed in a radical fashion analogous to polypectomy for colon adenomas.


RESULTS
The 22 patients (9 men and 13 women) had an average age of 58 +/- 14 years (range, 19-85 years). The median follow-up period was 169 days (range, 14-903 days). The papillary lesions ranged in size from 8 to 33 mm. The rate of concordance between the endoscopic forceps biopsy and the resected specimen was 50% (9/18) according to the Vienna classification. Complete endoscopic resections were performed for 17 of 22 the cases (77.3%). The median length of hospital stay was 4 days (range, 2-11 days), and there were no readmissions for complications. Endoscopic complications occurred for 5 (22.7%) of the 22 patients: postpapillectomy pancreatitis for 4 patients, bleeding for 1 patient, and retroperitoneal perforation for 1 patient. However, no procedure-related deaths occurred. After the papillectomy, a pathologically incomplete resection was noted in 10 cases, including submucosal invasion of an adenocarcinoma with lateral clean resection margins.


CONCLUSIONS
The findings showed that an endoscopic papillectomy was safe and effective for benign-appearing adenomas with negative biopsy results for a malignancy. This procedure should be considered as the initial intervention in such cases. The decision whether to perform a pancreatoduodenectomy can be made after the pathology report of the resected specimen is obtained from the endoscopic papillectomy.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyungpook National University Hospital, 50, Samduk-Dong 2 Ga, Chung-Gu, Daegu, 700-721, South Korea.
Min Kyu
MK
Jung
Chang Min
CM
Cho
Soo Young
SY
Park
Seong Woo
SW
Jeon
Won Young
WY
Tak
Young Oh
YO
Kweon
Sung Kook
SK
Kim
Yong Hwan
YH
Choi
D000236:Adenoma / Q000175:diagnosis / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000473:pathology / Q000601:surgery*; D001707:Biopsy, Needle; D016009:Chi-Square Distribution; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D003138:Common Bile Duct Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D009367:Neoplasm Staging; D016577:Pancreaticoduodenectomy / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D011336:Probability; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects / Q000379:methods; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult