title: Management after endoscopic snare papillectomy for ampullary adenomas.
abstract: OBJECTIVE
  This study was designed to investigate clinicopathological features of patients who underwent endoscopic snare papillectomy (ESP) and to suggest how to manage patients after the procedure according to the pathological findings.
  
  
  METHODS
  Seventy-nine patients underwent ESP for ampullary tumors in 7 tertiary medical centers in Korea. We retrospectively reviewed the medical records of each patient and analyzed the data.
  
  
  RESULTS
  Complete resection and complication rates of ESP were 76% and 21.7%, respectively; and pancreatitis rate was 11.5%. ESP-related mortality rate was 2.5% (n=2; 1 perforation and 1 pancreatitis). According to the pathological findings, endoscopic management was performed in 62/65 (95.4%) of low grade dysplasia (LGD) and 9/14 (64.3%) of high grade dysplasia (HGD)/cancer on pre-ESP; in 57/62 (92.0%) of LGD and 13/16 (81.3%) of HGD/cancer on ESP; and in 11/13(84.7%) of LGD and 0/6(0%) of HGD/cancer on follow-up biopsy. The rates of incomplete resection according to the pre-ESP pathological findings were 18.4% (12/65) in the LGD group and 50% (7/14) in the HGD/cancer group (p=0.033).
  
  
  CONCLUSIONS
  HGD or cancer required surgical management. Moreover, pre-procedural HGD/cancer was associated with a high rate of incomplete resection after ESP. Therefore, if the pre-ESP pathological results revealed HGD/cancer, a careful endoscopic follow-up with imaging study or an early surgical intervention should be considered.
authors.forename: Ji Hun
authors.initials: JH
authors.lastname: Kim
authors.forename: Jin Hong
authors.initials: JH
authors.lastname: Kim
authors.forename: Joe Chul
authors.initials: JC
authors.lastname: Hwang
authors.forename: Byung Moo
authors.initials: BM
authors.lastname: Yoo
authors.forename: Jong Ho
authors.initials: JH
authors.lastname: Moon
authors.forename: Dong Ki
authors.initials: DK
authors.lastname: Lee
authors.forename: Ho Gak
authors.initials: HG
authors.lastname: Kim
authors.forename: Young Deok
authors.initials: YD
authors.lastname: Cho
authors.forename: Don Haeng
authors.initials: DH
authors.lastname: Lee
authors.forename: Sang Heum
authors.initials: SH
authors.lastname: Park
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies