Endoscopic resection of ampullary lesions: Experience from a tertiary care centre

Aims Ampullary adenoma is a rare premalignant lesion, with an increasing incidence. Nevertheless, its detection has risen significantly in recent years, likely due to the increased utilization of endoscopic procedures. Although most cases are asymptomatic, clinical presentations can include jaundice, right upper quadrant abdominal pain, cholangitis, or acute pancreatitis secondary to biliary obstruction. Given the associated risk of malignant transformation, the standard treatment has historically been surgical resection. However, emerging evidence indicates that endoscopic resection may be equally effective while offering the advantages of reduced morbidity and lower recurrence rates in appropriately selected patients.

The aim of this study is to describe and evaluate short- and long-term outcomes of patients undergoing endoscopic papillectomy.

Methods A retrospective descriptive study was conducted on patients who underwent papillectomy at a tertiary care hospital between 2014 and 2023. Baseline patient characteristics, technical aspects of the endoscopic procedure, final histological results, and recurrence rates were analyzed. The definitions of outcomes were as follow: [1] curative resection: complete endoscopic resection without recurrence, [2] endoscopic success: no need for surgical intervention, [3] early recurrence: reconfirmed adenoma at the first endoscopic surveillance; and [4] late recurrence: reconfirmed adenoma after the first endoscopic surveillance.

Results A total of 31 patients underwent endoscopic papillectomy (mean age 63.2±17 years; 51.6% of patients were female). The mean lesion size was 18.8mm. Resection was performed en bloc in 61.3% of patients and in fragments (piecemeal) in 38.7%. The final histological diagnosis was adenoma in 74.19% of cases (67.7% with low-grade dysplasia and 19.4% with high-grade dysplasia), and adenocarcinoma in 12.9%.

Early complications occurred in 19.35% of patients, including acute pancreatitis (n=2), bleeding (n=2), and duodenal perforation (n=2); Clinical management was conservative in all cases, except for one patient who presented with perforation, which required surgical intervention. The mean follow-up period was 38.3±30 months. The endoscopic success rate was 87.19%. Early recurrence occurred in 10% of patients, while late recurrence was observed in 23.33%. There were no differences in recurrence rates in piecemeal resection compared to en –bloc resection (45.45% versus 20% respectively, P=0.21). The curative resection rate was 56.66% [5].

Conclusions Endoscopic papillectomy is a safe and effective procedure in the hands of experienced endoscopists. The complication rate is low, and most adverse events can be managed conservatively.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

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