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01-02-2019 | Endoluminal Surgery

New experience of endoscopic papillectomy for ampullary neoplasms

Authors: Shuling Li, Zikai Wang, Fengchun Cai, Enqiang Linghu, Gang Sun, Xiangdong Wang, Jiangyun Meng, Hong Du, Yunsheng Yang, Wen Li

Published in: Surgical Endoscopy | Issue 2/2019

Abstract

Aim

To establish the clinical value of endoscopic papillectomy for duodenal papillary tumor based on endoscopic and clinical characteristics.

Patients and methods

This single-center, retrospective study included 110 patients with duodenal papillary tumor who underwent endoscopic papillectomy between January 2006 and April 2017 at the gastrointestinal endoscopic center of the Chinese PLA General Hospital. Clinical data, postoperative pathology, procedure-related complications, and therapeutic outcomes were analyzed.

Results

Endoscopic papillectomy was technically feasible in all patients, and was mainly performed by four experienced endoscopists. The primary success rate of endoscopic papillectomy for ampullary neoplasms was 78.2%. A total of 13 patients experienced recurrence during a mean follow-up period of 16.28 months (range 6–132 months), the predictive factors that were related to recurrence were complete resection (53.8% vs. 94.2%; P = 0.001), and final pathology findings (P = 0.001). Delayed hemorrhage, the most common procedure-related complication, occurred in 20% (22/110) of patients and was significantly related to intraoperative bleeding (P = 0.042). Pancreatitis was the second most common complication, which was closely related to intraoperative bleeding requiring intervention (P = 0.040) and larger tumor size (P = 0.044). Histology, type of resection, stent placement, sphincterotomy, and duration of procedure were not related to post-procedure hemorrhage or pancreatitis. Older age (63.7 ± 13.5 vs. 57.4 ± 12.2; P = 0.033), jaundice (47.8% vs. 13.8%; P = 0.001), endoscopic forceps biopsy diagnosis of high-grade intraepithelial neoplasia (82.6% vs. 14.9%; P = 0.001), tumor size ≥ 2 cm (60.9% vs. 34.5%; P = 0.022), and dilation of the bile duct (34.8% vs. 9.2%; P = 0.006) were clinical features for ampullary carcinoma. The rate of complete resection (52.2% vs. 92.0%; P = 0.001) and recurrence (34.8% vs. 6.8%; P = 0.001) were also related to the diagnosis of ampullary carcinoma at final pathology.

Conclusions

Endoscopic papillectomy is a feasible and reasonable option for both diagnosis and treatment of tumors of the duodenal papilla in properly selected patients.

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Title: New experience of endoscopic papillectomy for ampullary neoplasms
Authors: Shuling Li
Zikai Wang
Fengchun Cai
Enqiang Linghu
Gang Sun
Xiangdong Wang
Jiangyun Meng
Hong Du
Yunsheng Yang
Wen Li
Publication date: 01-02-2019
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 2/2019
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-018-6577-2

At a glance: The STEP trials

Springer Medicine

New experience of endoscopic papillectomy for ampullary neoplasms

Abstract

Aim

Patients and methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Aim

Patients and methods

Results

Conclusions

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