Endoscopic versus surgical ampullectomy: an algorithm to treat disease of the ampulla of Vater.
OBJECTIVE
The objective of this study was to compare the effectiveness, morbidity, and mortality associated with endoscopic ampullectomy (EA) and surgical ampullectomy (SA).


BACKGROUND
The proposed management of benign ampullary lesions includes local resection (EA or SA) and en bloc resection (pancreaticoduodenectomy). Most agree that en bloc resection entails a significant morbidity and mortality. No study has previously compared EA and SA for the treatment of benign ampullary lesions.


METHODS
Medical records of patients selected for ampullectomy at Duke University Medical Center from 1991 to 2010 were reviewed.


RESULTS
After review, 109 patients were confirmed to have undergone ampullectomy for a suspected benign ampullary lesion. Sixty-eight patients underwent EA, whereas 41 patients underwent SA. Patients in each group were identical in terms of age, sex, race, and comorbid conditions, except that EA had a higher rate of severe obesity (body mass index >35). Endoscopic ampullectomy was found to have a significantly reduced length of stay, lower morbidity, and readmission rates, but it had similar rates of mortality, margin-positive excisions, and reinterventions.


CONCLUSIONS
In patients selected for ampullectomy for benign ampullary lesions, EA was found to have equivalent efficacy when compared with SA. Moreover, EA had lower morbidity and identical mortality. These findings suggest that patients would likely benefit from an aggressive endoscopic approach before consideration for surgery.
Department of General Surgery, Duke University Medical Center, Durham, NC, USA. eceppa@iupui.edu
Eugene P
EP
Ceppa
Rebecca A
RA
Burbridge
Kristy L
KL
Rialon
Philip A
PA
Omotosho
Dawn
D
Emick
Paul S
PS
Jowell
Malcom Stanley
MS
Branch
Theodore N
TN
Pappas
D000328:Adult; D000368:Aged; D000465:Algorithms; D014670:Ampulla of Vater; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D003138:Common Bile Duct Neoplasms / Q000601:surgery*; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome