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Short-term results of 42 endoscopic ampullectomies: a single-center experience.
MedLine Citation:
PMID:  21492053     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Abstract Objective. Benign lesions of the major papilla are rare but raise the problem of their medical care. We studied the efficacy, safety, and histology of the endoscopic ampullectomy. Patients and methods. Forty-two endoscopic resections of the major papilla were undertaken in 23 males and 19 females of a mean age of 63. Five patients (12%) presented with a familial adenomatous polyposis. The assessment of resectability included preoperative histology, and endoscopic ultrasound (EUS) in 26 patients (62%) always showing intra-mucosal lesion. The resection was performed with a duodenoscope, using a diathermic loop with a pure current section. Results. The resection was realized in one piece for 34 patients, in 2-4 fragments for 8 patients. A plastic pancreatic stent was inserted in 26 patients (62%), a plastic biliary stent in 10 patients (24%). There were no deaths but nine complications (21%): six acute pancreatitis (four patients with a pancreatic stent, contrary to the literature), three delayed gastrointestinal bleeding. The final histological result was fibrosis and inflammatory tissue in 7 patients, low-grade dysplasia in 20 patients, high-grade dysplasia or in situ carcinoma in 10 patients, invasive adenocarcinoma in 1 patient, and somatostatinoma in 2 patients (concordance of 72% with the initial histology). The resection was complete in 39 patients (93%). Three patients had additional surgery because of positive margin of resection or bad histology criteria. The median of follow-up in 33 patients with a complete resection was of 15 months, and we did not note any recurrence in 29 patients (88%). Conclusion. Endoscopic ampullectomy is an efficient treatment for superficial lesions of the papilla, despite a significant but rarely severe morbidity. Preoperative EUS is mandatory, preoperative histology is advisable. Long-term follow-up is necessary.
Authors:
Odile Jeanniard-Malet; Fabrice Caillol; Christian Pesenti; Erwan Bories; Geneviève Monges; Marc Giovannini
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-4-15
Journal Detail:
Title:  Scandinavian journal of gastroenterology     Volume:  -     ISSN:  1502-7708     ISO Abbreviation:  -     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-4-15     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0060105     Medline TA:  Scand J Gastroenterol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Oncological Medico-surgical Investigations, Institut Paoli-Calmettes, Marseille, France.
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