Combined excision and ablation of ampullary tumors with biliary or pancreatic intraductal extension is effective even in malignant neoplasms. Issue 3 (April 2019)

• Record Type: Journal Article
• Authors: Pérez-Cuadrado-Robles, Enrique; Piessevaux, Hubert; Moreels, Tom G; Yeung, Ralph; Aouattah, Tarik; Komuta, Mina; Dano, Hélène; Jouret-Mourin, Anne; Deprez, Pierre H
• Is Part Of: United European Gastroenterology journal. Volume 7:Issue 3(2019)
• Page Start: 369
• Page End: 376
• Publication Date: 2019-04
• Subjects: Ampullary tumor -- ampullectomy -- papillectomy -- ERCP -- cystotome -- thermal ablation; Gastroenterology -- Periodicals; Periodicals; 616.33005
• DOI: 10.1177/2050640618817215
• Languages: English
• ISSNs: 2050-6406

Abstract

Background: The feasibility and outcome of endoscopic resection in ampullary tumors with intraductal growth remains unclear. Objective: To assess the safety, feasibility and outcomes of these patients treated by thermal ablation. Methods: Retrospective observational study. All consecutive patients who underwent an endoscopic snare papillectomy with a 6-month minimum follow-up were included. Ablation was performed with cystotomes and soft/forced coagulation. Successful endoscopic treatment was defined as no adenomatous residual tissue or recurrence observed at follow-up. Results: Of 86 patients presenting with an ampullary tumor, 73 (58 ± 14 years old, 49% men, 34% familial adenomatous polyposis) (median tumor size: 20 mm, range: 8–80) were included. En bloc and curative resection rates were achieved in 46.6% and 83.6%, respectively. Intraductal ingrowth was seen in 18 (24.7%) patients and histologically confirmed in 12 (16.4%). Intraductal ablation achieved a 100% success rate, with a 20-month median follow-up. Most of these patients had malignant forms ( n = 8, 66.7%), with a higher adenocarcinoma rate (33.3% versus 3.3%, p = 0.001) compared to extraductal tumors. Overall, there was a 20.5% complication rate with no significant differences between both groups ( p = 0.676). Conclusions: Intraductal ablation achieves a high therapeutic success rate in ampullary tumors with ≤20 mm ductal extension, even in malignant forms or biliary and pancreatic involvement. The technique is feasible, cheap and safe and may avoid major surgery.