Endoscopic Resection of Advanced Ampullary Adenomas: a Single-center 14-year Retrospective Cohort Study

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2018 Sep 1

PMID 30167949

Citations 17

Authors

Sophia E van der Wiel

Jan-Werner Poley

Arjun D Koch

Marco J Bruno

Affiliations

Soon will be listed here.

Abstract

Background: Endoscopic ampullectomy has been recognized as a safe and reliable means to resect selective tumors of the ampulla of Vater and is associated with lower morbidity and mortality rates compared to surgical resection. Success rates range from 42 to 92%, with recurrences reported in up to 33%. Studies on endoscopic resection of advanced lesions such as those with intraductal extension of adenoma (IEA) and lateral spreading adenomas (LSA) are limited. We aimed to evaluate the technical success, complications, and recurrence of endoscopic resection of ampullary adenomas, including advanced lesions.

Methods: All patients referred to the Erasmus Medical Center for endoscopic resection of an ampullary lesion were retrospectively identified between 2002 and 2016. Endoscopic success was defined as complete excision of the adenoma, irrespective of the number of attempts, in the absence of recurrence.

Results: We included 87 patients with a median age of 65 years. Of these, 56 patients (64%) had an adenoma confined to the ampulla (ACA), 20 patients (23%) had an LSA, and 11 patients (13%) were treated for an IEA. The median lesion sizes were 24.6 mm, 41.4 mm, and 16.3 mm, respectively (P < 0.001). Complications occurred in 22 patients (25.3%), of which hemorrhage was most prevalent (12.6%), followed by perforation (8.1%). Complications were equally divided (P = 0.874). The median follow-up duration was 21.1 months (12-45.9) for ACA, 14.7 months (4.2-34.5) for LSA, and 5.8 months (3.7-22.0) for IEA (P = 0.051). Endoscopic resection was curative in 87.5% of patients with an ACA, 85% in patients with an LSA, and in only one patient with an IEA (P < 0.001). Recurrence occurred in 10 patients (11.5%) (P = 0.733).

Conclusion: Endoscopic ampullectomy is safe and highly successful in selected patients with an adenoma with or without lateral spreading. Outcomes of endoscopic treatment adenomas with an intraductal extension are less favorable and in these cases surgery should be considered.

Citing Articles

Factors associated with delayed bleeding following ampullectomy: A retrospective cohort study.

Pawlak K, Khalaf K, Gupta S, Tham D, Chon J, Mokhtar A DEN Open. 2025; 5(1):e70078.

PMID: 39959850 PMC: 11827579. DOI: 10.1002/deo2.70078.

Safety of intrabiliary radiofrequency ablation in cases of residual and recurrent neoplasia after endoscopic papillectomy.

Dahel Y, Caillol F, Ratone J, Zemmour C, Palen A, Garnier J Endosc Int Open. 2025; 13:a24872598.

PMID: 39958668 PMC: 11827740. DOI: 10.1055/a-2487-2598.

Modified Endoscopic Submucosal Dissection-An Alternative Modality for the Treatment of Sporadic Duodenal Papillary Adenomas.

Han Z, Li Q, Chua C, Wang Z, Zhong J, Huang Y Gastroenterol Res Pract. 2024; 2024:7444677.

PMID: 39450283 PMC: 11502125. DOI: 10.1155/2024/7444677.

Effectiveness of endoscopic papillectomy with stent placement in pancreatic and bile ducts for treating duodenal papillary adenoma: a retrospective study.

Jiang J, Lv F, Chen C, Jiang W BMC Gastroenterol. 2024; 24(1):379.

PMID: 39448906 PMC: 11515834. DOI: 10.1186/s12876-024-03466-7.

Prophylactic pancreatic duct stenting to reduce the risk of post-ampullectomy pancreatitis: a comprehensive review and meta-analysis of 1858 patients.

Chandan S, Canakis A, Deliwala S, Frohlinger M, Khan S, Mohan B Surg Endosc. 2024; 38(9):4798-4813.

PMID: 39030415 DOI: 10.1007/s00464-024-11019-y.

References

Scarpa A, Capelli P, Zamboni G, Oda T, Mukai K, Bonetti F . Neoplasia of the ampulla of Vater. Ki-ras and p53 mutations. Am J Pathol. 1993; 142(4):1163-72. PMC: 1886879. View

Pittayanon R, Imraporn B, Rerknimitr R, Kullavanijaya P . Advances in diagnostic endoscopy for duodenal, including ampullary, adenoma. Dig Endosc. 2014; 26 Suppl 2:10-5. DOI: 10.1111/den.12244. View

Espinel J, Pinedo E, Ojeda V, Guerra Del Rio M . Endoscopic management of adenomatous ampullary lesions. World J Methodol. 2015; 5(3):127-35. PMC: 4572025. DOI: 10.5662/wjm.v5.i3.127. View

Di Giorgio A, Alfieri S, Rotondi F, Prete F, Di Miceli D, Pericoli Ridolfini M . Pancreatoduodenectomy for tumors of Vater's ampulla: report on 94 consecutive patients. World J Surg. 2005; 29(4):513-8. DOI: 10.1007/s00268-004-7498-x. View

Posner S, Colletti L, Knol J, Mulholland M, Eckhauser F . Safety and long-term efficacy of transduodenal excision for tumors of the ampulla of Vater. Surgery. 2000; 128(4):694-701. DOI: 10.1067/msy.2000.108218. View

Napoleon B, Gincul R, Ponchon T, Berthiller J, Escourrou J, Canard J . Endoscopic papillectomy for early ampullary tumors: long-term results from a large multicenter prospective study. Endoscopy. 2014; 46(2):127-34. DOI: 10.1055/s-0034-1364875. View

Onkendi E, Naik N, Rosedahl J, Harmsen S, Gostout C, Baron Sr T . Adenomas of the ampulla of Vater: a comparison of outcomes of operative and endoscopic resections. J Gastrointest Surg. 2014; 18(9):1588-96. DOI: 10.1007/s11605-014-2543-z. View

Zadorova Z, Dvofak M, Hajer J . Endoscopic therapy of benign tumors of the papilla of Vater. Endoscopy. 2001; 33(4):345-7. DOI: 10.1055/s-2001-13693. View

Cheng C, Sherman S, Fogel E, McHenry L, Watkins J, Fukushima T . Endoscopic snare papillectomy for tumors of the duodenal papillae. Gastrointest Endosc. 2004; 60(5):757-64. DOI: 10.1016/s0016-5107(04)02029-2. View

10.

Binmoeller K, Boaventura S, Ramsperger K, Soehendra N . Endoscopic snare excision of benign adenomas of the papilla of Vater. Gastrointest Endosc. 1993; 39(2):127-31. DOI: 10.1016/s0016-5107(93)70051-6. View

11.

Catalano M, Linder J, Chak A, Sivak Jr M, Raijman I, Geenen J . Endoscopic management of adenoma of the major duodenal papilla. Gastrointest Endosc. 2004; 59(2):225-32. DOI: 10.1016/s0016-5107(03)02366-6. View

12.

Desilets D, Dy R, Ku P, Hanson B, Elton E, Mattia A . Endoscopic management of tumors of the major duodenal papilla: Refined techniques to improve outcome and avoid complications. Gastrointest Endosc. 2001; 54(2):202-8. DOI: 10.1067/mge.2001.116564. View

13.

Han J, Kim M . Endoscopic papillectomy for adenomas of the major duodenal papilla (with video). Gastrointest Endosc. 2006; 63(2):292-301. DOI: 10.1016/j.gie.2005.07.022. View

14.

Ridtitid W, Tan D, Schmidt S, Fogel E, McHenry L, Watkins J . Endoscopic papillectomy: risk factors for incomplete resection and recurrence during long-term follow-up. Gastrointest Endosc. 2013; 79(2):289-96. PMC: 4413454. DOI: 10.1016/j.gie.2013.08.006. View

15.

Seewald S, Omar S, Soehendra N . Endoscopic resection of tumors of the ampulla of Vater: how far up and how deep down can we go?. Gastrointest Endosc. 2006; 63(6):789-91. DOI: 10.1016/j.gie.2006.01.069. View

16.

Vleugels J, Hazewinkel Y, Dekker E . Morphological classifications of gastrointestinal lesions. Best Pract Res Clin Gastroenterol. 2017; 31(4):359-367. DOI: 10.1016/j.bpg.2017.05.005. View

17.

Ceppa E, Burbridge R, Rialon K, Omotosho P, Emick D, Jowell P . Endoscopic versus surgical ampullectomy: an algorithm to treat disease of the ampulla of Vater. Ann Surg. 2012; 257(2):315-22. DOI: 10.1097/SLA.0b013e318269d010. View

18.

Norton I, Gostout C, Baron T, Geller A, Petersen B, Wiersema M . Safety and outcome of endoscopic snare excision of the major duodenal papilla. Gastrointest Endosc. 2002; 56(2):239-43. DOI: 10.1016/s0016-5107(02)70184-3. View

19.

Bohnacker S, Seitz U, Nguyen D, Thonke F, Seewald S, deWeerth A . Endoscopic resection of benign tumors of the duodenal papilla without and with intraductal growth. Gastrointest Endosc. 2005; 62(4):551-60. DOI: 10.1016/j.gie.2005.04.053. View

20.

Boix J, Lorenzo-Zuniga V, Moreno de Vega V, Domenech E, Gassull M . Endoscopic resection of ampullary tumors: 12-year review of 21 cases. Surg Endosc. 2008; 23(1):45-9. DOI: 10.1007/s00464-008-9866-3. View