Can endoscopic papillectomy be curative for early ampullary adenocarcinoma of the ampulla of Vater?

Alvarez-Sánchez, María-Victoria; Oria, Ines; Luna, Olivia B.; Pialat, J; Gincul, Rodica; Lefort, Christine; Bourdariat, Raphaël; Fumex, Fabien; Lépilliez, Vincent; Scoazec, Jean Yves; Salgado‐Barreira, Ángel; Lemaistre, Anne Isabelle; Napoléon, Bertrand

doi:10.1007/s00464-016-5141-1

Cited by 23 publications

(25 citation statements)

References 32 publications

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“…6,[8][9][10] Most gastrointestinal mucosal tumors, such as colonic polyps or early gastric cancers, can be lifted from the submucosal layer by injecting saline solution or diluted epinephrine solution into the submucosal layer beneath the lesion of the gastrointestinal wall. This submucosal injection (SI) is thought to yield wider resection margins and prevent perforation and hemorrhage and is therefore commonly conducted when performing endoscopic mucosal resection or endoscopic submucosal dissection of such tumors, 11,12 as well as in endoscopic papillectomy.…”

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confidence: 99%

Effect of submucosal injection in endoscopic papillectomy of ampullary tumor: Propensity‐score matching analysis

et al. 2018

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Background: The role of submucosal injection (SI) in endoscopic papillectomy (EP) is controversial. Objective: This study investigated the effects of SI before EP of ampullary tumors. Methods: All patients who underwent initial curative EP at our institution between March 2006 and March 2014 were retrospectively recruited. The presence of residual tumor after three months, recurrence-free survival and post-procedural adverse events were compared between the SI group and non-injection (NI) group. Propensity-score matching was performed between the two groups to reduce potential selection bias and confounding. Results: A total of 122 patients were included (SI: 26, NI: 96). Following propensity-score matching, 25 paired patients were selected. Residual tumor was not shown in the NI group, whereas seven (28.0%) patients in the SI group had residual tumor (p ¼ 0.010). The recurrence-free survival of the NI group was significantly longer than that of the SI group (p ¼ 0.036). Upon multivariate analysis, pathologic grade (p ¼ 0.026) and SI (p ¼ 0.033) were significantly related to recurrence-free survival. Post-procedural adverse events were not significantly different between the two groups. Conclusion: SI before EP of ampullary tumor was related to more frequent residual tumor and shorter recurrence-free survival and did not reduce post-procedural adverse events.

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confidence: 99%

Effect of submucosal injection in endoscopic papillectomy of ampullary tumor: Propensity‐score matching analysis

et al. 2018

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“…After screening of titles and abstracts, 367 studies remained. Finally, 59 papers were eligible to be included into the meta-analysis after full-text evaluation (42 EA, 8 SA, 1 PD, 3 SA + PD, 4 EA + SA, 1 EA + PD; Figure 1 PRISMA chart) [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 ...…”

Section: Resultsmentioning

confidence: 99%

“…In addition, it is important to report the subtypes of ACs (intestinal vs. pancreaticobiliary), as they influence the risk of local or distant recurrences [85]. However, the discrimination of AC subtypes was reported in only two of all included EA studies [23,65] and in none of the surgical series. It is also important to note that EA is a recent technique that has improved over the years, and results from the 1990s or early 2000 might not be as good as today, regarding patient's selection, the rate of R0 resection and post procedure outcomes.…”

Section: Discussionmentioning

confidence: 99%

Systematic Review with Meta-Analysis: Endoscopic and Surgical Resection for Ampullary Lesions

Heise

Ali

Hasenclever

et al. 2020

JCM

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Ampullary lesions (ALs) can be treated by endoscopic (EA) or surgical ampullectomy (SA) or pancreaticoduodenectomy (PD). However, EA carries significant risk of incomplete resection while surgical interventions can lead to substantial morbidity. We performed a systematic review and meta-analysis for R0, adverse-events (AEs) and recurrence between EA, SA and PD. Electronic databases were searched from 1990 to 2018. Outcomes were calculated as pooled means using fixed and random-effects models and the Freeman-Tukey-Double-Arcsine-Proportion-model. We identified 59 independent studies. The pooled R0 rate was 76.6% (71.8–81.4%, I2 = 91.38%) for EA, 96.4% (93.6–99.2%, I2 = 37.8%) for SA and 98.9% (98.0–99.7%, I2 = 0%) for PD. AEs were 24.7% (19.8–29.6%, I2 = 86.4%), 28.3% (19.0–37.7%, I2 = 76.8%) and 44.7% (37.9–51.4%, I2 = 0%), respectively. Recurrences were registered in 13.0% (10.2–15.6%, I2 = 91.3%), 9.4% (4.8–14%, I2 = 57.3%) and 14.2% (9.5–18.9%, I2 = 0%). Differences between proportions were significant in R0 for EA compared to SA (p = 0.007) and PD (p = 0.022). AEs were statistically different only between EA and PD (p = 0.049) and recurrence showed no significance for EA/SA or EA/PD. Our data indicate an increased rate of complete resection in surgical interventions accompanied with a higher risk of complications. However, studies showed various sources of bias, limited quality of data and a significant heterogeneity, particularly in EA studies.

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“…The CAV is of low malignant potential , but the overall 5‐year survival rate of CAV after resection is lower than other gastrointestinal cancers such as gastric and colorectal cancers . The pancreaticoduodenectomy has undergone CAV as a standard surgical treatment, whereas such local resection as surgical or endoscopic procedures are conducted in some cases of cancers in early stage instead of pancreaticoduodenectomy involving high morbidity and mortality. However, no distinct criteria have been indicated between local resection and pancreaticoduodenectomy.…”

Section: Discussionmentioning

confidence: 99%

Microanatomical profiles on the lymphatic system in the human ampulla of Vater (immunohistochemistry and scanning electron microscopy)

Kagiya

Shimoda

Narita

et al. 2017

J Hepato Biliary Pancreat

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Can endoscopic papillectomy be curative for early ampullary adenocarcinoma of the ampulla of Vater?

Cited by 23 publications

References 32 publications

Effect of submucosal injection in endoscopic papillectomy of ampullary tumor: Propensity‐score matching analysis

Effect of submucosal injection in endoscopic papillectomy of ampullary tumor: Propensity‐score matching analysis

Systematic Review with Meta-Analysis: Endoscopic and Surgical Resection for Ampullary Lesions

Microanatomical profiles on the lymphatic system in the human ampulla of Vater (immunohistochemistry and scanning electron microscopy)

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