Ampullary Adenoma Treated by Endoscopic Double-Snare Retracting Papillectomy

Abstract

We report herein improved methods for the safe and successful completion of endoscopic papillectomy (EP). Between January 2008 and November 2011, 12 patients underwent double-snare retracting papillectomy for the treatment of lesions of the major duodenal papilla. The main outcomes were en bloc resection rates, pathological findings, and adverse events. All of the patients (mean age, 60.1 years; range, 38 to 80 years) were diagnosed with ampullary adenoma by endoscopic forceps biopsies prior to endoscopic snare papillectomy. En bloc resection by double-snare retracting papillectomy was successfully performed for all lesions (median size, 12.3 mm), comprising six tubular adenomas, one tubulovillous adenoma, three cases of epithelial atypia, one hamartomatous polyp, and one case of duodenitis with regenerative change. Significant hemorrhage and pancreatitis were observed in one case after EP. Adenoma recurrence occurred in three patients during follow-up (median, 28.5 months) at a mean interval of 2 months postoperatively (range, 1 to 3 months). No serious adverse events were observed. Double-snare retracting papillectomy is effective and feasible for treating lesions of the major duodenal papilla. Further treatment experience, including a single-arm phase II study, needs to be accumulated before conducting a randomized controlled study.

Endoscopic papillectomy for neoplastic ampullary lesions: A systematic review with pooled analysis

“…Of these, 29 articles matched the selection criteria and were finally included in the analysis. 12–41 Study characteristics and quality are comprehensively reported in Appendix 3. The baseline characteristics of the 1751 included patients are provided in Table 1.…”

“…After reviewing the title and abstract, 38 articles were retrieved as full text. Of these, 29 articles matched the selection criteria and were finally included in the analysis 12–41 . Study characteristics and quality are comprehensively reported in Appendix 3.…”

Case series of papillectomy by endoscopic retrograde cholangiopancreatography (ERCP)

“…The technique was endoscopic double-snare for all 12 patients. The ampullectomy of these patients was safe and complete ( 9 - 11 ).…”

A Comparison of Clinical Outcomes between Endoscopic Resection and Surgical Resection in Ampullary Tumors

“…However, the results of the new trials have limitations due to the small number of patients. The different guidelines for various lesions were applied in eligible studies, and the therapeutic effects of ER and SR can be variable according to the reports [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ]. In the current study, the overall information for the therapeutic effect and complication of ER was obtained through a meta-analysis.…”

“…Although surgical resection (SR) can have the possibility of complete resection, SR has higher morbidity and mortality compared to endoscopic resection (ER) [ 6 , 7 ]. In previous studies, ER showed a wide range of complete resection from 9.1% to 98.4% [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. The various factors can impact on variable rates.…”