Papillectomy for ampullary neoplasm: results of a single referral center over a 10-year period.
BACKGROUND
Tumors arising from the duodenal papilla account for approximately 5% of GI neoplasms, but are increasingly identified.


OBJECTIVE
To describe the clinical characteristics and outcomes in a large single-center experience with patients referred for ampullary lesions.


METHODS
A retrospective review of the Virginia Mason Medical Center endoscopy and hospital service database.


METHODS
Tertiary referral center.


METHODS
One hundred ninety-three patients referred for ampullary lesions from 1997 to 2007.


METHODS
Endoscopic management of ampullary lesions.


METHODS
The relationship of demographic and clinical data with endoscopic treatment and clinical outcomes in these patients.


RESULTS
One hundred ninety-three patients underwent endoscopy for ampullary lesions. Fifteen juxta-ampullary lesions and 10 normal variants were excluded. Among 168 patients, there were 112 (67%) adenomas, 38 (23%) adenocarcinomas, and 18 (10%) nonadenomatous lesions. There were 88 men and 80 women, with a mean age of 64 years. Clinical presentation included cholestasis/cholangitis (72 patients), abdominal pain (54 patients), incidental/asymptomatic (51 patients), pancreatitis (9 patients), and bleeding (7 patients). Of the 57 patients referred to surgery, 42 were sent directly without papillectomy, and 16 were sent after papillectomy. Papillectomies were performed in 102 patients with adenomatous lesions. The mean tumor size was 2.4 cm (range 0.5-6 cm). The papillectomy complication rate was 21%: mild pancreatitis in 10 (10%) patients, cholangitis in 1, retroperitoneal perforation in 1 (adenocarcinoma), intraperitoneal perforation in 1 (lateral extension), bleeding in 5 (lateral extension in 2 of these 5), and delayed papillary stenosis in 3. Recurrences were seen in 8%. The endoscopic success rate was 84%. Factors affecting success were a smaller adenoma size and the absence of dilated ducts.


CONCLUSIONS
Most ampullary adenomas are amenable to endoscopy. Underlying malignancy and lateral extension may be risk factors for bleeding and perforation. Smaller lesion size and the absence of dilated ducts are factors favorably affecting success.
Irani
Shayan
S
Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA.
Arai
Andrew
A
Ayub
Kamran
K
Biehl
Thomas
T
Brandabur
John J
JJ
Dorer
Russell
R
Gluck
Michael
M
Jiranek
Geoffrey
G
Patterson
David
D
Schembre
Drew
D
Traverso
L William
LW
Kozarek
Richard A
RA
D001706:Biopsy; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D010183:Pancreatic Ducts / Q000473:pathology / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000601:surgery*; D012017:Referral and Consultation; D012189:Retrospective Studies; D016896:Treatment Outcome