title: Short-term results of 42 endoscopic ampullectomies: a single-center experience.
abstract: OBJECTIVE
  Benign lesions of the major papilla are rare but raise the problem of their medical care. We studied the efficacy, safety, and histology of the endoscopic ampullectomy.
  
  
  METHODS
  Forty-two endoscopic resections of the major papilla were undertaken in 23 males and 19 females of a mean age of 63. Five patients (12%) presented with a familial adenomatous polyposis. The assessment of resectability included preoperative histology, and endoscopic ultrasound (EUS) in 26 patients (62%) always showing intra-mucosal lesion. The resection was performed with a duodenoscope, using a diathermic loop with a pure current section.
  
  
  RESULTS
  The resection was realized in one piece for 34 patients, in 2-4 fragments for 8 patients. A plastic pancreatic stent was inserted in 26 patients (62%), a plastic biliary stent in 10 patients (24%). There were no deaths but nine complications (21%): six acute pancreatitis (four patients with a pancreatic stent, contrary to the literature), three delayed gastrointestinal bleeding. The final histological result was fibrosis and inflammatory tissue in 7 patients, low-grade dysplasia in 20 patients, high-grade dysplasia or in situ carcinoma in 10 patients, invasive adenocarcinoma in 1 patient, and somatostatinoma in 2 patients (concordance of 72% with the initial histology). The resection was complete in 39 patients (93%). Three patients had additional surgery because of positive margin of resection or bad histology criteria. The median of follow-up in 33 patients with a complete resection was of 15 months, and we did not note any recurrence in 29 patients (88%).
  
  
  CONCLUSIONS
  Endoscopic ampullectomy is an efficient treatment for superficial lesions of the papilla, despite a significant but rarely severe morbidity. Preoperative EUS is mandatory, preoperative histology is advisable. Long-term follow-up is necessary.
authors.affiliation: Department of Oncological Medico-surgical Investigations, Institut Paoli-Calmettes, Marseille, France.
authors.forename: Odile
authors.initials: O
authors.lastname: Jeanniard-Malet
authors.forename: Fabrice
authors.initials: F
authors.lastname: Caillol
authors.forename: Christian
authors.initials: C
authors.lastname: Pesenti
authors.forename: Erwan
authors.initials: E
authors.lastname: Bories
authors.forename: Geneviève
authors.initials: G
authors.lastname: Monges
authors.forename: Marc
authors.initials: M
authors.lastname: Giovannini
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D014670:Ampulla of Vater / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002278:Carcinoma in Situ / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D004384:Duodenoscopy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D013005:Somatostatinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D015607:Stents; D016896:Treatment Outcome; D014463:Ultrasonography