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. 2020 Feb;3(1):17-25.
doi: 10.1093/jcag/gwz007. Epub 2019 Mar 18.

Endoscopic Resection of Ampullary Tumours: Long-term Outcomes and Adverse Events

Ali Alali  1   2 , Alberto Espino  1   3 , Maria Moris  1 , Myriam Martel  4 , Ingrid Schwartz  1 , Maria Cirocco  1 , Catherine Streutker  1 , Jeffrey Mosko  1 , Paul Kortan  1 , Alan Barkun  4 , Gary R May  1
Affiliations

Endoscopic Resection of Ampullary Tumours: Long-term Outcomes and Adverse Events

Ali Alali et al. J Can Assoc Gastroenterol. 2020 Feb.

Abstract

Background: The management of ampullary lesions has shifted from surgical approach to endoscopic resection. Previous reports were limited by small numbers of patients and short follow-up. The aim of this study is to describe short- and long-term outcomes in a large cohort of patients undergoing endoscopic ampullectomy.

Methods: Retrospective study of endoscopic ampullectomies performed at a tertiary center from January 1999 to October 2016. Information recorded includes patient demographics, clinical outcomes, lesion pathology, procedural events, adverse events and follow-up data.

Results: Overall, 103 patients underwent endoscopic resection of ampullary tumours (mean age 62.3 ± 14.3 years, 50.5% female, mean lesion size 20.9 mm; 94.9% adenomas, with a majority of lesions exhibiting low-grade dysplasia (72.7%). Complete endoscopic resection was achieved in 82.5% at initial procedure. Final complete endoscopic resection was achieved in all patients with benign pathology on follow-up procedures. Final pathology showed that 11% had previously undiagnosed invasive carcinoma. Delayed postprocedure bleeding occurred in 21.4%, all of which were managed successfully at endoscopy. Acute pancreatitis complicated 15.5% of procedures (mild in 93.8%). Perforation occurred in 5.8%, all treated conservatively except for one patient requiring surgery. Piecemeal resection was associated with significantly higher recurrence compared to en-bloc resection (54.3% versus 26.2%, respectively, P = 0.012). All recurrences were treated endoscopically.

Conclusion: Endoscopic ampullectomy appears both safe and effective in managing patients with ampullary tumours in experienced hands. Most adverse events can be managed conservatively. Many patients develop recurrence during long-term follow-up but can be managed endoscopically. Recurrence rates may be reduced by performing initial en-bloc resection.

Keywords: Adenoma; Ampulla; Ampullectomy; ERCP; Polypectomy.

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Figures

Figure 1.
Figure 1.
The endoscopic steps of endoscopic resection (ER) for ampullary tumours. (A) Inspection of ampullary tumour; (B, C): Cannulation of pancreatic and biliary ducts; (D) Submucosal injection; (E) Snaring; (F) The lesion is entirely entrapped by the snare; (G) En-bloc resection; (H) Stenting; and (I) Duodenal view 3 months after ER.
Figure 2.
Figure 2.
Duration of hospital stay among patients with and without complications.
See this image and copyright information in PMC

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