2213 Endoscopic snare ampullectomy for resection of benign ampullary neoplasm in 25 patients

Autor: John Martin, Paul Kortan, Roland Ter, Gregory B. Haber, Ryan Ponnudurai, Donald G. Ormonde, Gurpal S. Sandha
Rok vydání: 2000
Předmět:
Zdroj: Gastrointestinal Endoscopy. 51:AB57
ISSN: 0016-5107
DOI: 10.1016/s0016-5107(00)14010-6
Popis: Background: Benign ampullary neoplasms have traditionally been managed by surgical local excision or Whipple resection. Endoscopic techniques now provide a means of non-operative local resection. Patients and Methods: 25 pts (17 males) underwent endoscopic resection from 1989 to 1999. Mean age was 62.2 yrs (34-83). 7 pts has Familial Adenomatous Polyposis (FAP). 21 of 25 pts has sphincterotomy prior to or at ampullectomy. Resections were performed using a therapeutic duodenoscope. A monopolar polypectomy snare was employed for piecemeal (n=20) or enblock (n=5)resection. 18 pts had submucosal saline injections. Argon Plasma Coagulation (APC) was used in 6 and YAG Laser in 3 to ablate residual tissue. 20 pts had pancreatic stents to prevent pancreatitis and 6 had common bile duct stents. Results: Follow up range from 1-97 mos (average 22.5). Ampullectomy was successful in all patients with a mean of 1.3 procedures. Histology: 11 had tubulovillous adenoma, 11 tubular adenoma, 2 hamartomas, 1 adenomyoma. 9 pts had high grade and 5 had low grade dysplasia. 3 out of 9 had foci of intramucosal carcinoma. 1 died from perioperative complications, 2 refused surgery. Total recurrance rate for adenomas was 32% (8/25). The recurrance in the non FAP pts was 16.7% (3/18). In the FAP group, initial pathology showed severe dysplasia in 4 and mild dysplasia in 2. All FAP pts had reoccurance of adenoma (2 with low grade dysplasia) at follow up biopsy. Complications: 30 day: Pancreatitis - 3 mild, 1 severe (died-no pancreatic stent placement). Bleeding - 3 (2 endoscopic hemoclips, 1 surgery). Overall morbidity was 27%, mortality 4%. Conclusions: Endoscopic resection is indicated for benign ampullary tumors. Tissue acquisition is important in ruling out underlying malignancy and no patients in this series developed carcinoma in follow up. Current practice should include placement of a pancreatic stent to prevent severe pancreatitis.
Databáze: OpenAIRE
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