Endoscopy 2020; 52(S 01): S299
DOI: 10.1055/s-0040-1704953
ESGE Days 2020 ePoster presentations
Colon and rectum 09:00–17:00 Thursday, April 23, 2020 ePoster area
© Georg Thieme Verlag KG Stuttgart · New York

SINGLE CENTER EXPERIENCE OF ENDOSCOPIC PAPILLECTOMY

I Nedoluzhko
1   Moscow Clinical Scientific Center n.a AS.Loginov, Operative Endoscopy, Moscow, Russian Federation
,
E Khon
1   Moscow Clinical Scientific Center n.a AS.Loginov, Operative Endoscopy, Moscow, Russian Federation
,
K Shishin
1   Moscow Clinical Scientific Center n.a AS.Loginov, Operative Endoscopy, Moscow, Russian Federation
,
L Shumkina
1   Moscow Clinical Scientific Center n.a AS.Loginov, Operative Endoscopy, Moscow, Russian Federation
,
N Kurushkina
1   Moscow Clinical Scientific Center n.a AS.Loginov, Operative Endoscopy, Moscow, Russian Federation
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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    Aims Operative endoscopy have significantly impacted the clinical approach to the patients with ampullary tumors. Pancreaticoduodenectomy or transduodenal papillectomy have been performed to treat ampullary tumors. However, endoscopic papillectomy (EP) is becoming the procedure of choice in the selected group of patients.

    Methods 46 patients with ampullary tumors who underwent endoscopic papillectomy between 2014 and 2019 were reviewed. 27 women (58,7%) and 19 men (41,3%). Mean age 53 ±27y.o. Selection criteria for EP were: tumor diameter less than 4 cm, no endoscopic evidence of malignancy and no intraductal infiltration more than 1 cm.

    Papillectomy was performed in snare technique. Submucosal injection was performed only for the lateral spreading components of the tumor. For lesions not resectable “en block”, a piecemeal was performed. In case of any residual tissue, it was obligatorily resected. Pancreatic stent was routinely placed in order to reduce risk of acute pancreatitis. Hemostasis was performed if needed

    Results Papillectomy was successfully performed in all 47 cases (one patient underwent EP twice). En block resection was completed in 26 cases (55%), piecemeal resection in 21 (45%). Pancreatic stent was successfully placed in 33 cases (70%). Postoperative complication rate is 27.6 %, including bleeding (8 cases, 17%), perforation (3 cases, 6%), acute pancreatitis (2 cases, 4.2%). All of the episodes of bleeding were resolved endoscopically; episodes of acute pancreatitis were treated conservatively. One patient with perforation was treated using minimally invasive techniques, two patients underwent surgery. Procedure related mortality rate is 4.2 % (2 cases). Local recurrence rate occurred in 1 case (2.1%), patient underwent second endoscopic papillectomy. Histopathology reported adenocarcinoma in 5 cases (10%), neuroendocrine tumor in 1 case (2.1%)

    Conclusions Endoscopic papillectomy is effective treatment for ampullary tumors in the selected group of patients. Regardless considerable morbidity rate, most of them can be managed conservatively or endoscopically


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