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

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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.

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Abbreviations

EUS:

Endoscopic ultrasound

ERCP:

Endoscopic retrograde cholangiopancreaticography

FAP:

Familial adenomatous polyposis

CIS:

Carcinoma in situ

NA:

Not applicable

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Disclosures

W. Laleman, A. Verreth, B. Topal, R. Aerts, M. Komuta, T. Roskams, S. Van der Merwe, D. Cassiman, F. Nevens, C. Verslype, and W. Van Steenbergen have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Liver and Biliopancreatic Disorders, University Hospital Gasthuisberg, KU Leuven, Herestraat 49, 3000, Leuven, Belgium

    Wim Laleman, Annelies Verreth, Schalk Van der Merwe, David Cassiman, Frederik Nevens, Chris Verslype & Werner Van Steenbergen

  2. Department of Abdominal Surgery, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium

    Baki Topal & Raymond Aerts

  3. Department of Pathology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium

    Mina Komuta & Tania Roskams

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  1. Wim Laleman
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Correspondence to Wim Laleman.

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W. Laleman and A. Verreth share first authorship.

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Laleman, W., Verreth, A., Topal, B. et al. Endoscopic resection of ampullary lesions: a single-center 8-year retrospective cohort study of 91 patients with long-term follow-up. Surg Endosc 27, 3865–3876 (2013). https://doi.org/10.1007/s00464-013-2996-2

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