Is endoscopic papillectomy safe for ampullary adenomas with high-grade dysplasia?
OBJECTIVE
This study was designed to provide safe management guidelines for ampullary adenoma by analysis of clinicopathological features.


BACKGROUND
The treatment of ampullary cancer has been established; however, the indications for treatment of ampullary adenoma remain controversial.


METHODS
Between July 1997 and July 2008, a total of 33 patients were diagnosed with ampullary adenoma prior to procedures: 20 endoscopic papillectomies (ESP), 5 transduodenal resections (TDR), and 8 pancreatoduodenectomies (PD).


RESULTS
The false-negative rate of biopsy for cancer was 27.5% (8/29). Coexistence of cancer in patients with pre-high-grade dysplasia (HGD) was 50.0% (5/10), whereas it was 15.7% in pre-low-grade dysplasia (LGD). In addition, the rate of recurrence was 80% (8/10) in patients with pre-HGD. The size of tumor by final pathology was 1.27 +/- 0.89 cm in LGD, 1.81 +/- 0.99 cm in HGD, and 1.98 +/- 1.08 cm in cancer group. There was a significant correlation between size of tumor and final pathology (P = 0.036). According to receiver operating characteristic (ROC) curve, criterion to predict HGD/cancer was tumor size larger than 1.5 cm; sensitivity and specificity were 55.6% and 80.0%, respectively, and likelihood ratio was 2.778. However, size of tumor was not associated with preprocedural pathology.


CONCLUSIONS
Ampullary adenoma with preprocedural HGD was highly associated with coexistence of cancer and recurrence. Moreover, most of large tumors were treated by surgical procedures and proved to be cancer. Therefore, we suggest that ampullary adenoma with preprocedural HGD or more than 1.5 cm should not be managed with endoscopic papillectomy due to high associated rates of recurrence.
Kim
Ji Hun
JH
Departments of Surgery, School of Medicine, Ajou University, Suwon, Korea.
Kim
Jin Hong
JH
Han
Jae Ho
JH
Yoo
Byung Moo
BM
Kim
Myung Wook
MW
Kim
Wook Hwan
WH
D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D014670:Ampulla of Vater / Q000473:pathology / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D016577:Pancreaticoduodenectomy; D011379:Prognosis; D015996:Survival Rate