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- Title
Therapeutic outcomes of endoscopic papillectomy for ampullary neoplasms: retrospective analysis of a multicenter study.
- Authors
Sung Hoon Kang; Kook Hyun Kim; Tae Nyeun Kim; Min Kyu Jung; Chang Min Cho; Kwang Bum Cho; Ji Min Han; Ho Gak Kim; Hyun Soo Kim; Kang, Sung Hoon; Kim, Kook Hyun; Kim, Tae Nyeun; Jung, Min Kyu; Cho, Chang Min; Cho, Kwang Bum; Han, Ji Min; Kim, Ho Gak; Kim, Hyun Soo
- Abstract
<bold>Background: </bold>Endoscopic papillectomy (EP) is reported to be a relatively safe and reliable procedure for complete resection of ampullary neoplasms. The aim of this study was to evaluate the therapeutic outcomes and complications of EP for ampullary neoplasms.<bold>Methods: </bold>A retrospective multicenter study was conducted with 5 participating centers from January 2007 to July 2014. A total of 104 patients who underwent EP for ampullary neoplasms were reviewed retrospectively. EP was performed by snare resection with or without submucosal lifting of the lesion.<bold>Results: </bold>The mean age of patients was 60.5 ± 12.1 years, and the male-to-female ratio was 2.0:1. En bloc resection was possible in 94 patients (90.3%). A biliary and a pancreatic stent were placed after EP in 42 patients and in 60 patients, respectively. A pathologically incomplete resection was noted in 11 cases (10.6%), and 5 of these patients were treated with additional endoscopic procedure. Histology of resected specimens was as follows: low grade adenoma (43.2%), high grade adenoma (14.4%), adenocarcinoma (16.3%), hyperplastic polyp (7.7%), and others (18.4%). Of the 75 cases with low grade adenoma on biopsy specimen, 21.3% turned out to have high grade adenoma (12%) or adenocarcinoma (9.3%). Procedure-related complications occurred in 33 patients (31.7%); bleeding (18 cases, 17.3%), pancreatitis (16 cases, 15.4%), and perforation (8 cases, 7.7%). Pre-EP ERCP, saline lifting, sphincterotomy, biliary stenting, pancreatic stenting, specimen size, and cauterization were not related to post EP complications. Surgery was performed in 6 cases with pathological incomplete resection and 2 cases with complications after EP, and there were 2 cases of mortality due to complications. During follow-up endoscopy after initial success of EP, remnant tumors were found in 7 patients, one of whom underwent surgery and the others were treated endoscopically. Consequently, the overall endoscopic success rate of EP was 89.4%.<bold>Conclusions: </bold>Endoscopic papillectomy appears to be an effective treatment for ampullary neoplasms, and can be considered as an alternative to surgery. However, relatively high risk of procedure related complications is a problem that must be considered.
- Subjects
ENDOSCOPY; TUMOR surgery; RETROSPECTIVE studies; ADENOMA; SURGICAL complications; HEALTH outcome assessment; THERAPEUTICS; DUODENUM surgery; COMPARATIVE studies; RESEARCH methodology; MEDICAL cooperation; RESEARCH; BILE duct tumors; EVALUATION research; TREATMENT effectiveness; ENDOSCOPIC gastrointestinal surgery
- Publication
BMC Gastroenterology, 2017, Vol 17, p1
- ISSN
1471-230X
- Publication type
journal article
- DOI
10.1186/s12876-017-0626-5