Endoscopic Papillectomy

Aims Adenomas are the most common benign lesions of the ampulla of Vater and have the potential to undergo a malignant transformation which makes complete removal of adenoma essential. Endoscopic papillectomy is increasingly used as an alternative to surgery for benign ampullary tumors. The aim is to evaluate the effectiveness of endoscopic papillectomy.

Methods 59 endoscopic snare papillectomy was performed in 58 patients with ampullary tumors from 2014 until 2020. One patient underwent the operation repeatedly. There were 37 women (64 %) and 21 men (36 %). Inclusion criteria were: tumor diameter less than 4 cm, no evidence of malignancy and no intraductal infiltration more than 1 cm.

Results Papillectomy was successfully performed in all cases. En bloc resection was completed in 40 cases (68 %), piecemeal in 19 (32 %). A pancreatic stent was placed in 46 cases (78 %). The early postoperative complication rate is 28.8 %, including delayed bleeding (10 cases, 17 %), perforation (4 cases, 6.8 %), acute pancreatitis (3 cases, 5 %). The procedure-related mortality rate is 3,3 % (2 cases). Local recurrence occurred in one case (1.6 %), 2 years after the endoscopic papillectomy and was removed endoscopically. Final histology showed adenoma in 42 cases (71 %), hyperplastic polyp in 3 (5 %), papillitis in 4 (7 %), neuroendocrine tumor in 3 (5 %) and adenocarcinoma in 7 cases (12 %). Two patients with adenocarcinoma and one patient with neuroendocrine tumors were referred to surgery. One patient was referred to chemotherapy due to the cancer dissemination, and two patients due to the R0 resection margins are under endoscopic surveillance and no recurrence has been found to date. The last 4 patients refused any medical treatment in our center.

Conclusions Endoscopic papillectomy is an effective treatment for benign ampullary tumors. Compared to surgery, endoscopic papillectomy is associated with lower morbidity and mortality and can be beneficial for certain ampullary tumors.

Citation: Khon E, Nedoluzhko I, Shishin K et al. OP89 ENDOSCOPIC PAPILLECTOMY. Endoscopy 2021; 53: S38.

Publication History

Article published online:
19 March 2021