title: Endoscopic snare papillectomy: a single institutional experience of a standardized technique. A retrospective cohort study.
abstract: BACKGROUND
  Indications for endoscopic snare papillectomy (ESP) remain controversial. Main concerns with ESP are related to the incomplete removal of the lesion, high recurrence rates and inadequate oncological resection. Aim of the study is to report short and long term outcomes after endoscopic papillectomy in a single institutional series with strict inclusion criteria and a standardized technique.
  
  
  METHODS
  Patients with ampullary tumors who underwent endoscopic papillectomy over a 5 year period were reviewed. Inclusion criteria for endoscopic resection were: tumor diameter less than 3 cm, no endoscopic evidence of malignancy, absence of infiltration of biliary and pancreatic duct at pre-operative ERCP and tumor confined to the submucosa at EUS. An en-block resection was attempted in all cases, followed by a pancreatic stent insertion whenever possible.
  
  
  RESULTS
  Twenty-seven patients (10 female, mean age 68 y) have been identified. Ampullectomy was successfully performed in all the cases. En bloc resection was completed in 24 patients (88.8%), while 3 patients had a piecemeal resection. A pancreatic stent was successfully placed in all the patients. Five patients experienced complications, including bleeding (2 cases, 7.4%) and acute pancreatitis (3 cases, 11.1%). There was no procedure-related mortality. Histology revealed a poor prognosis in two patients, which were subsequently treated by duodenopancreatectomy. Over a long-term follow-up (median 18 months), one patient developed local recurrence, which was successfully treated with further endoscopic resection. Overall curative resection rate was 92.6%.
  
  
  CONCLUSIONS
  Endoscopic ampullectomy allows resection of benign tumors and in situ carcinoma. Strict indications and a proper standardized technique seem to be key factors in order to achieve excellent short and long-term results.
authors.affiliation: Department of Clinical Medicine and Surgery, Center of Excellence for Technical Innovation in Surgery (CEITC), University of Naples Federico II, School of Medicine, Naples, Italy. Electronic address: giovanni.depalma@unina.it.
authors.forename: Giovanni D
authors.initials: GD
authors.lastname: De Palma
authors.affiliation: Department of Clinical Medicine and Surgery, Center of Excellence for Technical Innovation in Surgery (CEITC), University of Naples Federico II, School of Medicine, Naples, Italy. Electronic address: gaetano.luglio@gmail.com.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Luglio
authors.affiliation: Department of Clinical Medicine and Surgery, Center of Excellence for Technical Innovation in Surgery (CEITC), University of Naples Federico II, School of Medicine, Naples, Italy. Electronic address: francescomaione79@gmail.com.
authors.forename: Francesco
authors.initials: F
authors.lastname: Maione
authors.affiliation: Department of Clinical Medicine and Surgery, Center of Excellence for Technical Innovation in Surgery (CEITC), University of Naples Federico II, School of Medicine, Naples, Italy. Electronic address: espodario83@gmail.com.
authors.forename: Dario
authors.initials: D
authors.lastname: Esposito
authors.affiliation: Department of Clinical Medicine and Surgery, Center of Excellence for Technical Innovation in Surgery (CEITC), University of Naples Federico II, School of Medicine, Naples, Italy. Electronic address: sicils@tin.it.
authors.forename: Saverio
authors.initials: S
authors.lastname: Siciliano
authors.affiliation: Department of Clinical Medicine and Surgery, Center of Excellence for Technical Innovation in Surgery (CEITC), University of Naples Federico II, School of Medicine, Naples, Italy. Electronic address: nicogenna74@gmail.com.
authors.forename: Nicola
authors.initials: N
authors.lastname: Gennarelli
authors.affiliation: Department of Clinical Medicine and Surgery, Center of Excellence for Technical Innovation in Surgery (CEITC), University of Naples Federico II, School of Medicine, Naples, Italy. Electronic address: gian.cassese@studenti.unina.it.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Cassese
authors.affiliation: Department of Clinical Medicine and Surgery, Center of Excellence for Technical Innovation in Surgery (CEITC), University of Naples Federico II, School of Medicine, Naples, Italy. Electronic address: marcellopersico@hotmail.com.
authors.forename: Marcello
authors.initials: M
authors.lastname: Persico
authors.affiliation: Department of Clinical Medicine and Surgery, Center of Excellence for Technical Innovation in Surgery (CEITC), University of Naples Federico II, School of Medicine, Naples, Italy. Electronic address: forestie@unina.it.
authors.forename: Pietro
authors.initials: P
authors.lastname: Forestieri
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000601:surgery*; D002278:Carcinoma in Situ / Q000601:surgery; D003138:Common Bile Duct Neoplasms / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010179:Pancreas / Q000601:surgery; D010183:Pancreatic Ducts; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
keywords: Duodenoscopy; Endoscopic papillectomy; Major duodenal papilla; Tumor of major duodenal papilla