title: Endoscopic resection of ampullary lesions: a single-center 8-year retrospective cohort study of 91 patients with long-term follow-up.
abstract: BACKGROUND
  Endoscopic ampullectomy is established as a valuable treatment for adenomas of the Vaterian papilla. Few large series are available, however, let alone any with long-term follow-up. Moreover, multiple tangible issues remain. The aim of our study was to evaluate efficacy, safety, and outcome of endoscopic ampullectomy and compare it to existing literature
  
  
  METHODS
  This is a single-center, retrospective study with a minimal follow-up of 3 years including 91 patients, including familial adenomatous polyposis (FAP) and non-FAP, who had an endoscopic ampullectomy between 2000 and 2008. Outcome parameters included ampulloma characteristics, biotical accuracy as well as safety, efficacy, recurrence rate, and survival after endoscopic ampullectomy.
  
  
  RESULTS
  Endoscopic resection was successful in 71 patients (78%). Histological review of the resected specimens revealed nonspecific changes (13.8%), low or medium grade dysplasia (52.9%), high grade dysplasia (21.8%) and carcinoma (18.3%). Bioptic accuracy was 38.3%. Overall complications were observed in 23 patients (25.2%): pancreatitis (15.4%), hemorrhage (12.1%) and cholangitis (4.9%). Recurrence occurred in 18.3%. Fourteen patients underwent pancreaticoduodenectomy. Survival after complete endoscopic ampullectomy was excellent for patients with low to moderate grade dysplasia and high grade dysplasia. Incomplete endoscopic resection of high grade dysplasia or invasive carcinoma was associated with unfavorable outcome when treated merely endoscopically.
  
  
  CONCLUSIONS
  Endoscopic ampullectomy is obligatory for assessment of the true histological nature of an ampulloma. Endoscopic resection is a safe and efficient procedure for adenomas with low to moderate dysplasia but also for high grade dysplastic lesions, provided that a complete endoscopic resection is achieved.
authors.affiliation: Department of Liver and Biliopancreatic Disorders, University Hospital Gasthuisberg, KU Leuven, Herestraat 49, 3000, Leuven, Belgium, wim.laleman@uzleuven.be.
authors.forename: Wim
authors.initials: W
authors.lastname: Laleman
authors.forename: Annelies
authors.initials: A
authors.lastname: Verreth
authors.forename: Baki
authors.initials: B
authors.lastname: Topal
authors.forename: Raymond
authors.initials: R
authors.lastname: Aerts
authors.forename: Mina
authors.initials: M
authors.lastname: Komuta
authors.forename: Tania
authors.initials: T
authors.lastname: Roskams
authors.forename: Schalk
authors.initials: S
authors.lastname: Van der Merwe
authors.forename: David
authors.initials: D
authors.lastname: Cassiman
authors.forename: Frederik
authors.initials: F
authors.lastname: Nevens
authors.forename: Chris
authors.initials: C
authors.lastname: Verslype
authors.forename: Werner
authors.initials: W
authors.lastname: Van Steenbergen
mesh_terms: D000236:Adenoma / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000235:genetics / Q000473:pathology / Q000601:surgery*; D011125:Adenomatous Polyposis Coli / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002277:Carcinoma / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000235:genetics / Q000473:pathology / Q000601:surgery; D002278:Carcinoma in Situ / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000235:genetics / Q000473:pathology / Q000601:surgery; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000706:statistics & numerical data; D002761:Cholangitis / Q000453:epidemiology / Q000209:etiology; D003138:Common Bile Duct Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000235:genetics / Q000473:pathology / Q000601:surgery*; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000601:surgery; D016577:Pancreaticoduodenectomy; D010195:Pancreatitis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome