Abstract
Background
The utility of endoscopic ampullectomy versus surgical ampullectomy remains a topic of debate, particularly for the treatment of malignant tumors. The goal of this study was to prospectively establish the outcomes of endoscopic ampullectomy, with focus on carcinoma.
Methods
From February 2002 to December 2008, 61 patients underwent endoscopic ampullectomy. The ampulloma was discovered fortuitously in the majority of cases (43 patients, 70%). All patients had had an echoendoscopy revealing a T1N0 lesion without invasion of the orifice.
Results
Forty-three patients (70%) underwent a monobloc resection. Histological analysis revealed a low-grade dysplastic adenoma in 21 patients (35%), a high-grade dysplastic adenoma in 11 patients (18%), no dysplasia in 16 patients (26%), an adenocarcinoma in 10 patients (16%), and a well-differentiated endocrine carcinoma in 3 patients (5%). Among the ten patients with adenocarcinoma, four with adenocarcinoma of poor prognosis were treated by pancreaticoduodenectomy (PD) with R0 resection, of whom one patient had no more lesion. Two intramucosal adenocarcinomas were cured by endoscopic ampullectomy without any recurrence. Four patients received palliative care after endoscopic ampullectomy due to cephalic pancreatico-duodenectomy contraindication. For the three patients with well-differentiated endocrine carcinomas, one was treated by PD with R0 resection and two were treated solely by endoscopic ampullectomy, without recurrence. Eleven patients (18%) presented with complications. The complication rate was 30.5% for carcinomas versus 14.5% for benign tumors (p < 0.05).
Conclusion
Endoscopic ampullectomy allows for the oncologic resection of well-differentiated intramucosal carcinomas with negative margins. The risk of complications is greater for papillary carcinomas.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bohnacker S, Soehendra N, Maguchi H et al (2006) Endoscopic resection of benign tumors of the papilla of vater. Endoscopy 38(5):521–525
Rosenberg J, Welch JP, Pyrtek LJ et al (1986) Benign villous adenomas of the ampulla of Vater. Cancer 58(7):1563–1568
Jagelman DG, DeCosse JJ, Bussey HJ (1988) Upper gastrointestinal cancer in familial adenomatous polyposis. Lancet 1(8595):1149–1151
Kim MH, Lee SK, Seo DW et al (2001) Tumors of the major duodenal papilla. Gastrointest Endosc 54:609–620
Napoléon B, Barthet M, Saurin JC et al (2003) Les risques de l’ampullectomie endoscopique sont-ils assez faibles pour en faire une alternative à la chirurgie ? Résultats d’une étude rétrospective multicentrique. Gastroenterol Clin Biol 27:A79
Norton AD, Gostout CJ, Baron TH et al (2002) Safety and outcome of endoscopic snare excision of the major duodenal papilla. Gastrointest Endosc 56:239–243
Catalano MF, Linder JD, Chak A et al (2004) Endoscopic management of adenoma of the major duodenal papilla. Gastrointest Endosc 59:225–232
Yoshida T, Matsumoto T, Shibata K (2000) Patterns of lymph node metastasis in carcinoma of the ampulla of Vater. Hepatogastroenterology 47:880–883
Shirai Y, Ohtani T, Tsukuda K et al (1997) Patterns of lymphatic spread of carcinoma of the ampulla of Vater. Br J Surg 84:1012–1016
Binmoeller KF, Seifert H, Gerke H et al (1996) Papillary roof incision using the Erlangen-type pre-cut papillotome to achieve selective bile duct cannulation. Gastrointest Endosc 44(6):689–695
Zádorová Z, Dvofák M, Hajer J (2001) Endoscopic therapy of benign tumors of the papilla of Vater. Endoscopy 33:345–347
Desilets DJ, Dy RM, Ku PM et al (2001) Endoscopic management of tumors of the major duodenal papilla: refined techniques to improve outcome and avoid complications. Gastrointest Endosc 54:202–208
Irani S, Arai A, Ayub K et al (2009) Papillectomy for ampullary neoplasm: results of a single referral center over a 10-year period. Gastrointest Endosc 70(5):923–932
Itoh A, Goto H, Naitoh Y et al (1997) Intraductal ultrasonography in diagnosing tumor extension of cancer of the papilla of Vater. Gastrointest Endosc 45:251–260
Napoléon B (2004) Should the classification of ampullar tumors be revisited? Ann Pathol 24:309–311
Lee SY, Jang KT, Lee KT et al (2006) Can endoscopic resection be applied for early stage ampulla of Vater cancer? Gastrointest Endosc 63:783–788
Yoon SM, Kim MH, Kim MJ et al (2007) Focal early stage cancer in ampullary adenoma: surgery or endoscopic papillectomy? Gastrointest Endosc 66:701–707
Harewood GC, Pochron NL, Gostout CJ (2005) Prospective randomized controlled trial of prophylactic pancreatic stent placement for endoscopic snare excision of the duodenal ampulla. Gastrointest Endosc 62:367–370
Choudhary A, Bechtold ML, Arif M, Szary NM, Puli SR, Othman MO, Pais WP, Antillon MR, Roy PK (2011) Pancreatic stents for prophylaxis against post-ERCP pancreatitis: a meta-analysis and systematic review. Gastrointest Endosc 73:275–282
Mazaki T, Masuda H, Takayama T (2010) Prophylactic pancreatic stent placement and post-ERCP pancreatitis: a systematic review and meta-analysis. Endoscopy 42:842–853
Zolotarevsky E, Fehmi M, Anderson MA, Schoenfeld PS, Elmunzer BJ, Kwon RS, Piraka CR, Wamsteker EJ, Schelman JM, Korsnes SJ, Normolle DP, Kim HM, Elta GH (2011) Prophylactic 5-Fr pancreatic duct stents are superior to 3-Fr stents: a randomized controlled trial. Endoscopy 43:325–330
Disclosures
S. Salmi, S. Ezzedine, V. Vitton, C. Ménard, J.-M. Gonzales, A. Desjeux, J.-C. Grimaud, and M. Barthet have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Salmi, S., Ezzedine, S., Vitton, V. et al. Can papillary carcinomas be treated by endoscopic ampullectomy?. Surg Endosc 26, 920–925 (2012). https://doi.org/10.1007/s00464-011-1968-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-011-1968-7