Abstract

CASTANO LLANO, Rodrigo et al. Local experience in endoscopy ampullectomy. Rev Col Gastroenterol [online]. 2007, vol.22, n.3, pp.173-189. ISSN 0120-9957.

Background. Tumors of the major papillae can be malignant or premalignant, and traditionally are treated by surgical excision. This study evaluated the safety and the outcome of endoscopic snare resection of benign lesions and it reviews the technique and results of other series. Methods. All patients with tumors of the major papilla treated by endoscopic snare resection over a 10-year period (2001-2006) were evaluated. Patients with tumors that had frank endoscopic features of malignancy and those proven to be cancerous by biopsy were excluded. Papillectomy was performed by electrosurgical snare resection. A pancreatic stent frequently was placed after excision. Endoscopic surveillance was at the discretion of the endoscopist. Results. Sixteen snare resections were performed in 15 patients (mean age 66 years). Histopathologic diagnoses were the following: six patients with adenoma with low grade dysplasia, five adenoma with focal high-grade dysplasia (2 with intraductal extension), four papillae adenocarcinoma. None patients had familial adenomatous polyposis. Two underwent surgical resection because of carcinoma, and 11 were successfully treated by endoscopic papillectomy alone. During follow-up (mean 42,4 months), one patients had adenoma recurrence, one died after Whipple operation and one died of ampullar carcinoma, and 13 are awaiting follow-up. Of the 2 patients with intraductal adenoma per cholangiogram, none underwent surgical resection, both had intraductal plasma argon therapy and one patient present with adenoma recurrence and was retreated with plasma argon. Of the 4 patients with adenocarcinoma, pancreaticoduodenectomy was performed in 2 and palliative papillectomy was performed in 2 unsuitable for surgery. There were 5 procedure related complications (33%), including two pancreatitis (13%), two cholangitis (13%) and one bleeding without transfusion (7%). There was no procedure-related death. Conclusions. Most adenomas of the duodenal papillae can be fully resected by snare papillectomy. Endoscopic therapy appears to be a reasonable alternative to surgery for management of papillary tumors. Longer follow-up is needed to determine the true recurrence rate and if endoscopic retreatments are effective

Keywords : Ampullectomy; ampulla of Vater adenoma; therapeutic endoscopy.

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