Endoscopy 2018; 50(04): S68-S69
DOI: 10.1055/s-0038-1637230
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Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC PAPILLECTOMY: LONG TERM RESULTS IN 110 CONSECUTIVE PATIENTS

G Valerii
1   Catholic University of Rome, Digestive Endoscopy Unit, Rome, Italy
,
A Tringali
1   Catholic University of Rome, Digestive Endoscopy Unit, Rome, Italy
,
V Bove
1   Catholic University of Rome, Digestive Endoscopy Unit, Rome, Italy
,
R Landi
1   Catholic University of Rome, Digestive Endoscopy Unit, Rome, Italy
,
F Barbaro
1   Catholic University of Rome, Digestive Endoscopy Unit, Rome, Italy
,
I Boškoski
1   Catholic University of Rome, Digestive Endoscopy Unit, Rome, Italy
,
P Familiari
1   Catholic University of Rome, Digestive Endoscopy Unit, Rome, Italy
,
V Perri
1   Catholic University of Rome, Digestive Endoscopy Unit, Rome, Italy
,
G Costamagna
1   Catholic University of Rome, Digestive Endoscopy Unit, Rome, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

Also available at
 

Aims:

Ampullary adenomas represents 5% of the neoplasia of the gastrointestinal tract with a premalignant nature. Aim of this study is to evaluate the results and the long-term follow-up of endoscopic papillectomy (EP) of adenoma of the ampulla of Vater.

Methods:

Consecutive patients undergoing EP between May 2000 and October 2017.

The following data were recorded: size of the ampullary lesion, pre- and post-EP histology, complications, local recurrence rate and survival. Endoscopic follow-up was scheduled after 1, 3, 6 and 12 months for the first year, and then yearly for the following 5 years.

Results:

EP was performed in 110 consecutive patients (61 F, mean age 59.2). 77.3% en-bloc resection, 22.7% piecemeal. 28 patients (25.4%) had familiar adenomatous polyposis (FAP).

Biliary sphincterotomy with or without insertion of a plastic stent was performed after EP in 77 patient (70%).

Histopatological findings are summarized in table 1.

Tab. 1:

Endoscopic papillectomy: histopatological results

Low Grade Dysplasia, n (%)

27 (24.5)

High Grade Dysplasia, n (%)

36 (32.7)

High Grade Dysplasia + focal Adenocarcinoma, n (%)

17 (15.4)

Intramucosal Adenocarcinoma, n (%)

24 (22.0)

Neuroendocrine tumor, n (%)

6 (5.4)

Delayed bleeding was reported in 19 patients (17.3%) treated endoscopically, except in 1 case.

Retroperitoneal perforations occurred in 3/110 (2.7%) cases and were successfully treated by surgical (n = 2) or percutaneous (n = 1) drainage.

Regular follow-up was available in 94/110 patients (85.4%), mean 31.6 months (range 1 – 108).

Residual and recurrent adenomas were diagnosed in 28 (29.8%) and 19 (20.2%) cases, respectively and were successfully retreated endoscopically except in 4 cases treated by surgery.

Nine patients (8.2%) with adenocarcinoma on final histology, were referred to surgery.

Conclusions:

EP is effective with favorable long-term outcomes avoiding invasive surgical procedures. The high incidence of residual/recurrent adenoma is balanced by the successful endoscopic re-treatment.