Surgical Endoscopy

, Volume 27, Issue 10, pp 3865–3876

Endoscopic resection of ampullary lesions: a single-center 8-year retrospective cohort study of 91 patients with long-term follow-up

  • Wim Laleman
  • Annelies Verreth
  • Baki Topal
  • Raymond Aerts
  • Mina Komuta
  • Tania Roskams
  • Schalk Van der Merwe
  • David Cassiman
  • Frederik Nevens
  • Chris Verslype
  • Werner Van Steenbergen
Article

DOI: 10.1007/s00464-013-2996-2

Cite this article as:
Laleman, W., Verreth, A., Topal, B. et al. Surg Endosc (2013) 27: 3865. doi:10.1007/s00464-013-2996-2

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.

Keywords

Adenoma  Endoscopic ampullectomy  Endoscopic papillectomy  High grade dysplasia  Papilla of vater  Periampullary tumor 

Abbreviations

EUS

Endoscopic ultrasound

ERCP

Endoscopic retrograde cholangiopancreaticography

FAP

Familial adenomatous polyposis

CIS

Carcinoma in situ

NA

Not applicable

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Wim Laleman
    • 1
  • Annelies Verreth
    • 1
  • Baki Topal
    • 2
  • Raymond Aerts
    • 2
  • Mina Komuta
    • 3
  • Tania Roskams
    • 3
  • Schalk Van der Merwe
    • 1
  • David Cassiman
    • 1
  • Frederik Nevens
    • 1
  • Chris Verslype
    • 1
  • Werner Van Steenbergen
    • 1
  1. 1.Department of Liver and Biliopancreatic DisordersUniversity Hospital Gasthuisberg, KU LeuvenLeuvenBelgium
  2. 2.Department of Abdominal SurgeryUniversity Hospital Gasthuisberg, KU LeuvenLeuvenBelgium
  3. 3.Department of PathologyUniversity Hospital Gasthuisberg, KU LeuvenLeuvenBelgium