| Papillectomy for ampullary neoplasm: results of a single referral center over a 10-year period. | |
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MedLine Citation:
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PMID: 19608181 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Tumors arising from the duodenal papilla account for approximately 5% of GI neoplasms, but are increasingly identified. OBJECTIVE: To describe the clinical characteristics and outcomes in a large single-center experience with patients referred for ampullary lesions. DESIGN: A retrospective review of the Virginia Mason Medical Center endoscopy and hospital service database. SETTING: Tertiary referral center. PATIENTS: One hundred ninety-three patients referred for ampullary lesions from 1997 to 2007. INTERVENTIONS: Endoscopic management of ampullary lesions. MAIN OUTCOME MEASUREMENTS: The relationship of demographic and clinical data with endoscopic treatment and clinical outcomes in these patients. RESULTS: One hundred ninety-three patients underwent endoscopy for ampullary lesions. Fifteen juxta-ampullary lesions and 10 normal variants were excluded. Among 168 patients, there were 112 (67%) adenomas, 38 (23%) adenocarcinomas, and 18 (10%) nonadenomatous lesions. There were 88 men and 80 women, with a mean age of 64 years. Clinical presentation included cholestasis/cholangitis (72 patients), abdominal pain (54 patients), incidental/asymptomatic (51 patients), pancreatitis (9 patients), and bleeding (7 patients). Of the 57 patients referred to surgery, 42 were sent directly without papillectomy, and 16 were sent after papillectomy. Papillectomies were performed in 102 patients with adenomatous lesions. The mean tumor size was 2.4 cm (range 0.5-6 cm). The papillectomy complication rate was 21%: mild pancreatitis in 10 (10%) patients, cholangitis in 1, retroperitoneal perforation in 1 (adenocarcinoma), intraperitoneal perforation in 1 (lateral extension), bleeding in 5 (lateral extension in 2 of these 5), and delayed papillary stenosis in 3. Recurrences were seen in 8%. The endoscopic success rate was 84%. Factors affecting success were a smaller adenoma size and the absence of dilated ducts. CONCLUSIONS: Most ampullary adenomas are amenable to endoscopy. Underlying malignancy and lateral extension may be risk factors for bleeding and perforation. Smaller lesion size and the absence of dilated ducts are factors favorably affecting success. |
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Authors:
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Shayan Irani; Andrew Arai; Kamran Ayub; Thomas Biehl; John J Brandabur; Russell Dorer; Michael Gluck; Geoffrey Jiranek; David Patterson; Drew Schembre; L William Traverso; Richard A Kozarek |
Publication Detail:
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Type: Comparative Study; Journal Article Date: 2009-07-15 |
Journal Detail:
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Title: Gastrointestinal endoscopy Volume: 70 ISSN: 1097-6779 ISO Abbreviation: Gastrointest. Endosc. Publication Date: 2009 Nov |
Date Detail:
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Created Date: 2009-11-02 Completed Date: 2010-01-19 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0010505 Medline TA: Gastrointest Endosc Country: United States |
Other Details:
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Languages: eng Pagination: 923-32 Citation Subset: IM |
Affiliation:
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Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Biopsy Endoscopy, Gastrointestinal / methods* Female Hospitals, University* Humans Male Middle Aged Pancreatectomy / methods* Pancreatic Ducts / pathology, surgery* Pancreatic Neoplasms / diagnosis, surgery* Referral and Consultation* Retrospective Studies Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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