Impact of technical modification of endoscopic papillectomy for ampullary neoplasm on the occurrence of complications.
OBJECTIVE
To evaluate the usefulness of a modified technique of endoscopic papillectomy (EP) for lessening the occurrence of complications.


METHODS
Indications for EP were adenoma or well-differentiated adenocarcinoma confined to the papilla of Vater (T1) without tumor spread into the bile/pancreatic duct. Sixteen patients underwent the modified technique, which consists of resection with the Endocut mode, followed by biliary/pancreatic sphincterotomy and stenting (Group A). Twelve patients who had undergone EP, using a cutting current, followed by pancreatic duct stenting were included as control (Group B). The frequency of complications and clinical outcomes were retrospectively compared between the two groups.


RESULTS
Sixteen patients had adenoma, and 12 had adenocarcinoma. Early complications occurred in 36% of all patients (hemorrhage, 7; cholangitis, 3; perforation, 2; cholecystitis, 1). The frequency of early complications in Group A was significantly lower than that in Group B (6% vs 75%, odds ratio [OR] 0.022, 95% confidence interval [CI], 0.0020-0.25). Late complications occurred in 18% of the patients (bile duct stone, 3; hemorrhage, 1; pancreatitis, 1). There was no significant difference in the late complication rate between Group A and Group B (19% vs 17%). Local recurrences were found in 14% of the patients, without a significant difference between Group A and Group B (19% vs 8%) during a mean follow-up period. All recurrent tumors were successfully treated with argon plasma coagulation.


CONCLUSIONS
The modified technique of EP for ampullary neoplasm contributed to lessening the occurrence of early complications. However, further refinement of this technique is necessary for improving the clinical outcome.
Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan. keiito@openhp.or.jp
Kei
K
Ito
Naotaka
N
Fujita
Yutaka
Y
Noda
Go
G
Kobayashi
Takashi
T
Obana
Jun
J
Horaguchi
Shinsuke
S
Koshita
Yoshihide
Y
Kanno
Takahisa
T
Ogawa
Yusuke
Y
Kato
Yasunobu
Y
Yamashita
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D000236:Adenoma / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000473:pathology / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D017075:Laser Coagulation; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000628:therapy; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic / Q000379:methods*; D018709:Statistics, Nonparametric; D015607:Stents