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Review
. 2024 Jul 22;16(7):e65076.
doi: 10.7759/cureus.65076. eCollection 2024 Jul.

Endoscopic Versus Surgical Treatment for Ampullary Lesions: A Systematic Review With Meta-Analysis

Luiza Martins Baroni  1 , Mateus Pereira Funari  2 , Angelo So Taa Kum  3 , Alexandre Moraes Bestetti  4 , Luiza Bicudo de Oliveira  5 , Matheus Ferreira de Carvalho  5 , Tomazo Antonio Prince Franzini  1 , Diogo Turiani Hourneaux de Moura  4 , Wanderley Marques Bernardo  3 , Eduardo Guimarães Hourneaux de Moura  4
Affiliations
Review

Endoscopic Versus Surgical Treatment for Ampullary Lesions: A Systematic Review With Meta-Analysis

Luiza Martins Baroni et al. Cureus. .

Abstract

Ampullary lesions (ALs) can be treated through either an endoscopic approach (EA) or a surgical approach (SA). However, it is important to note that EAs carry a significant risk of incomplete resection, while opting for surgical interventions can result in substantial morbidity. We performed a systematic review and meta-analysis for R0 resection, recurrence, adverse events in general, major adverse events, mortality, and length of hospital stay between SAs and EAs. Electronic databases were searched from inception to 2023. We identified nine independent studies. The risk difference was -0.32 (95% CI: -0.50, -0.15; p <0.001) for R0, 0.12 (95% CI: 0.06, 0.19; p < 0.001) for recurrence, -0.22 (95% CI: -0.43, 0.00; p 0.05) for overall adverse events, -0.11 (95% CI: -0.32, 0.10; p = 0.31) for major complications, -0.01 (95% CI: -0.02, 0.01; p = 0.43) for mortality, and -14.69 (95% CI: -19.91, -9.47; p < 0.001) for length of hospital stay. As expected, our data suggest a higher complete resection rate and lower recurrence from surgical interventions, but this is associated with an elevated risk of adverse events and a longer hospital stay.

Keywords: ampulla of vater; ampullary adenoma; duodenal neoplasms; endoscopy; pancreaticoduodenectomy; surgery.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Study selection flowchart according to the PRISMA guidelines
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analysis
Figure 2
Figure 2. Risk of bias assessment using ROBINS-I
[7,13,20-26] ROBINS-I: risk of bias in nonrandomized studies - of intervention
Figure 3
Figure 3. Forest plot for complete resection
Figure 4
Figure 4. Forest plot for recurrence
Figure 5
Figure 5. Forest plot for overall adverse events
Figure 6
Figure 6. Forest plot for major adverse events
Figure 7
Figure 7. Forest plot for mortality
Figure 8
Figure 8. Forest plot for length of hospital stay
See this image and copyright information in PMC

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