title: Feasibility of snare papillectomy in ampulla of Vater tumors: meta-analysis and study results from a tertiary referral center.
abstract: OBJECTIVE
  Ampulla of Vater tumors represent a rare tumor entity and bear a malignant potential. This study at our tertiary referral center aimed at evaluating the feasibility of endoscopic snare papillectomy and long-term endoscopic surveillance in comparison to results of a meta-analysis of comparative trials.
  
  
  METHODS
  Retrospective study in comparison to results of a meta-analysis. Twenty-one patients (mean age 60.2±12.8 years) with ampullary adenoma were included. All patients had undergone ERCP with endoscopic forceps biopsies prior to endoscopic snare papillectomy. Statistical analysis was applied including descriptive analysis of symptoms, therapy and complications.
  
  
  RESULTS
  ESP was technically successful in all 21 patients. Histopathology showed 18 adenomas and 3 focal adenocarcinomas which were referred to surgery for modified Whipple's procedure. Follow-up was available in all patients with a mean follow-up of 64 months. Adenoma recurrence occurred in three patients with a mean recurrence time of 25 months (range, 4-66 months). One patient had residual adenoma growth.
  
  
  CONCLUSIONS
  In the majority of cases ampullary adenomas can be treated endoscopically. Forceps biopsies alone are not reliable enough in detecting malignancy. All patients with ampullary tumor should therefore undergo ESP. Due to the recurrence rate of 16% patients should have close follow-up.
authors.affiliation: Department of Medicine B, University of Muenster, Muenster, Germany.
authors.forename: Hauke S
authors.initials: HS
authors.lastname: Heinzow
authors.forename: Philipp
authors.initials: P
authors.lastname: Lenz
authors.forename: Frank
authors.initials: F
authors.lastname: Lenze
authors.forename: Dirk
authors.initials: D
authors.lastname: Domagk
authors.forename: Wolfram
authors.initials: W
authors.lastname: Domschke
authors.forename: Tobias
authors.initials: T
authors.lastname: Meister
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D014670:Ampulla of Vater / Q000473:pathology / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D001706:Biopsy; D003138:Common Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D016145:Endoscopy, Digestive System / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D018365:Neoplasm, Residual; D012017:Referral and Consultation; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome