Z Gastroenterol 2013; 51 - A12
DOI: 10.1055/s-0033-1347462

Endoscopic papillectomy for adenomas of the Ampulla of Vater

L Czakó 1, V Terzin 1, Á Báthori 1, T Wittmann 1
  • 11st Department of Medicine, University of Szeged, Szeged, Hungary

Background: Endoscopic papillectomy (EP) with curative intent is increasingly performed for benign ampullary tumors. This study aimed at evaluating the feasibility and efficacy of EP in adenoma of the ampulla of Vater.

Methods: Between January 2010 and February 2013, 14 patients (5 men and 9 women with an average age of 72.8 ± 7.6 years; range 61 – 85 years) underwent EP for adenoma arising from the ampulla of Vater at our tertiary referral center. Two patients had previous transduodenal removal of ampullary adenoma. Endoscopic resection was performed in a radical fashion analogous to polypectomy for colon adenomas.

Results: An EP was technically feasible in all patients. En bloc and complete endoscopic resections were achieved in 10 (71%) and 11 (78%) cases, respectively. 8 adenomas (52%), 6 with low grade and 2 with high grade dysplasia, 3 carcinomas in adenoma (21%), and 3 hyperplastic polyps (21%) were the final histopathological diagnoses of the endoscopic specimens. The complete concordance between the previous endoscopic forceps biopsy and the resected specimen was only 44%. The 2 adenocarcinoma cases were referred for surgery, because of incomplete resection. The median length of hospital stay was 3,8 days (range, 2 – 6 days). No recurrences were experienced during the follow-up period in the completely resected cases. Mild postpapillectomy pancreatitis occurred in 1 patients (7%) and painless hyperamylasemia in 2 cases. Postpapillectomy pancreatitis and dilatation of the Wirsung duct developed in a patients 1 year after the procedure; pancreatic papillotomy was therefore performed.

Conclusions: Vater papilla adenomas can be treated endoscopically effectively with low complication rate. Forceps biopsy alone is not sufficiently reliable enough for the identification of malignancy. These lesions should therefore be fully resected by EP for a final diagnosis and possibly definitive treatment. Ampullary cancer was associated with a high rate of incomplete resection after EP.