Endoscopic snare papillectomy for adenoma of the ampulla of vater: Long-term results in 135 consecutive patients

Dig Liver Dis. 2020 Sep;52(9):1033-1038. doi: 10.1016/j.dld.2020.05.029. Epub 2020 Jun 10.

Abstract

Background: The premalignant nature of ampullary adenomas justifies their radical excision.

Aims: Aim of this study is to evaluate the long-term results of endoscopic snare papillectomy in a consecutive series of patients with ampullary adenomas.

Methods: Patients who underwent endoscopic snare papillectomy between October 1999 and October 2017 were identified from an electronic database. Endoscopic snare papillectomy was performed en bloc, when possible; a pancreatic stent or a nasopancreatic drainage were inserted. Endoscopic follow-up was scheduled after 3, 6 and 12 months for the first year, then yearly.

Results: Endoscopic snare papillectomy was performed in 135 patients (70 M, mean age 60.5 years) by en bloc (83%) or piecemeal (17%) resection. Delayed bleeding occurred in 16 patients (11.8%), infected retroperitoneal collections in 6 patients (4.4%), pancreatitis in 4 patients (3%). One patient died (0.7%). Follow-up was available in 103/114 (90.3%) patients. In case of residual (24.3%) and recurrent (23.3%), adenomas endoscopic retreatment was successful in 42/49 cases (85.7%). After a mean follow-up of 40 months, 93.2% (96/103) of the patients were disease free CONCLUSION: Endoscopic snare papillectomy of ampullary adenomas is effective with favorable long-term outcomes. Compliance to the scheduled follow-up is important for the early detection and re-treatment of recurrences.

Keywords: Ampullary adenomas; Ampullary neoplasm; Duodenopancreatectomy; Endoscopic papillectomy.

MeSH terms

  • Adenoma / surgery*
  • Adult
  • Aged
  • Aged, 80 and over
  • Ampulla of Vater / surgery*
  • Common Bile Duct Neoplasms / surgery*
  • Databases, Factual
  • Female
  • Humans
  • Italy
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local
  • Pancreatic Neoplasms / surgery*
  • Postoperative Complications / etiology
  • Retrospective Studies
  • Sphincterotomy, Endoscopic / adverse effects*
  • Treatment Outcome