Endoscopic snare papillectomy for adenoma of the ampulla of vater: Long-term results in 135 consecutive patients. Issue 9 (September 2020)

• Record Type: Journal Article
• Authors: Tringali, Andrea; Valerii, Giorgio; Boškoski, Ivo; Familiari, Pietro; Landi, Rosario; Perri, Vincenzo; Costamagna, Guido
• Is Part Of: Digestive and liver disease. Volume 52:Issue 9(2020)
• Page Start: 1033
• Page End: 1038
• Publication Date: 2020-09
• Subjects: Ampullary neoplasm -- Ampullary adenomas -- Endoscopic papillectomy -- Duodenopancreatectomy; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; 616.33005
• DOI: 10.1016/j.dld.2020.05.029
• Languages: English
• ISSNs: 1590-8658

Abstract

Abstract: Background: The premalignant nature of ampullary adenomas justifies their radical excision. Aims: Aim of this study is to evaluate the long-term results of endoscopic snare papillectomy in a consecutive series of patients with ampullary adenomas. Methods: Patients who underwent endoscopic snare papillectomy between October 1999 and October 2017 were identified from an electronic database. Endoscopic snare papillectomy was performed en bloc, when possible; a pancreatic stent or a nasopancreatic drainage were inserted. Endoscopic follow-up was scheduled after 3, 6 and 12 months for the first year, then yearly. Results: Endoscopic snare papillectomy was performed in 135 patients (70 M, mean age 60.5 years) by en bloc (83%) or piecemeal (17%) resection. Delayed bleeding occurred in 16 patients (11.8%), infected retroperitoneal collections in 6 patients (4.4%), pancreatitis in 4 patients (3%). One patient died (0.7%). Follow-up was available in 103/114 (90.3%) patients. In case of residual (24.3%) and recurrent (23.3%), adenomas endoscopic retreatment was successful in 42/49 cases (85.7%). After a mean follow-up of 40 months, 93.2% (96/103) of the patients were disease free Conclusion: Endoscopic snare papillectomy of ampullary adenomas is effective with favorable long-term outcomes. Compliance to the scheduled follow-up is important for the early detection and re-treatment of recurrences.