Endoscopic management of adenomatous ampullary lesions

Espinel, Jesús

doi:10.5662/wjm.v5.i3.127

Cited by 19 publications

(13 citation statements)

References 82 publications

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“…The detection of ampullary adenomas has increased over the last years most likely due to the more abundant use of esophagogastroduodenoscopy and ultrasonography [ 2 ]. As in colorectal adenomas, ampullary adenomas can undergo malignant transformation, and therefore it is essential to completely remove the lesion [ 3 ]. Historically ampullary adenomas have been resected surgically [ 4 , 5 ].…”

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confidence: 99%

“…Over the last decades, endoscopic ampullectomy (EA) has been recognized as a safe and reliable alternative treatment for selective tumors of the ampulla of Vater [ 5 – 7 ]. EA has lower morbidity and mortality rates than surgical procedures [ 3 , 8 ]. Success rates after EA have been reported within a wide range from 46 to 92% and are largely based on retrospective, heterogeneous case series.…”

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confidence: 99%

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Endoscopic resection of advanced ampullary adenomas: a single-center 14-year retrospective cohort study

et al. 2018

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Endoscopic resection of advanced ampullary adenomas: a single-center 14-year retrospective cohort study

et al. 2018

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“…In addition, ALs can cause cholangitis or pancreatitis and thereby reduce patients' quality of life. Thus, treatment of ALs either by EA, SA or PD is indicated in all cases [2][3][4]80]. Nevertheless, prospective randomized trials comparing EA, SA or PD are lacking and the treatment of AL for non-invasive lesions, carcinoma in situ and T1-node-negative adenocarcinoma is far from a consensus.…”

Section: Discussionmentioning

confidence: 99%

“…Nowadays, most ALs are incidentally diagnosed by endoscopy or radiology imaging. However, in symptomatic patients, painless jaundice and cholangitis, acute pancreatitis, nausea, vomiting or weight loss have been described [3]. Most ALs are ampullary adenomas (AA) and adenocarcinomas (AC) following an adenoma-to-carcinoma sequence [4].…”

Section: Introductionmentioning

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 most common presentation in symptomatic patients is painless jaundice (50-75%). Rare manifestations are cholangitis, acute pancreatitis as well as nausea, vomiting, biliary colic and weight loss (8).…”

Section: Introductionmentioning

confidence: 99%

Study Protocol of the ESAP Study: Endoscopic Papillectomy vs. Surgical Ampullectomy vs. Pancreaticoduodenectomy for Ampullary Neoplasm—A Pancreas2000/EPC Study

Hollenbach

Ali

Auriemma³

et al. 2020

Front. Med.

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Background: Lesions of the Ampulla of Vater are a rare condition and represent <10% of peri-ampullary neoplasms. Nevertheless, ampullary adenomas have the potential for malignant transformation to ampullary carcinomas by an adenoma-to-carcinoma sequence. Thus, adequate patient selection and complete resection (R0) of non-invasive ampullary lesions either by endoscopic papillectomy (EP), surgical ampullectomy (SA), or pancreaticoduodenectomy (PD) is essential. Although PD was traditionally performed, recent studies reported considerable efficacy and fewer complications following EP and SA. Since consistent comparative data are lacking, the Endoscopic Papillectomy vs. Surgical Ampullectomy vs. Pancreaticoduodectomy (ESAP) study will provide evidence for a therapeutic standard and post procedure morbidity in ampullary lesions. Methods: International multicenter retrospective study. Adult patients (>18 years of age) who underwent SA or PD for ampullary neoplasm between 2004 and 2018 or EP between 2007 and 2018 will be evaluated. Main inclusion criteria are ampullary lesions strictly located to the ampulla. This includes adenoma, adenocarcinoma (T 1 and T 2), neuroendocrine tumors, gastrointestinal stroma tumors and other rare conditions. Exclusion criteria are peri-ampullary lesions, e.g., from the duodenal wall or the head of the pancreas, and interventions for tumor stages higher than T 2. The main objective of this study is to analyze rates of complete resection (R0), recurrence and necessity for complementary interventions following EP, SA, and PD. Treatment-quality for each procedure will be defined by morbidity, mortality and complication rates and will be compared between EP, SA, and PD. Secondary objectives include outcome for patients with incomplete resection or initially understated tumors, lesions of the minor papilla, Hollenbach et al. ESAP hereditary syndromes, neuroendocrine tumors, mesenchymal lesions, and other rare conditions. Additionally, we will analyze therapy by argon plasma coagulation and radiofrequency ablation. Furthermore, outcome in curative and palliative interventions can be distinguished. Conclusion: The ESAP study will provide evidence for therapeutic algorithms and data for the implementation of guidelines in the treatment of different types of ampullary tumors, including recurrent, or incomplete resected lesions.

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Endoscopic management of adenomatous ampullary lesions

Cited by 19 publications

References 82 publications

Endoscopic resection of advanced ampullary adenomas: a single-center 14-year retrospective cohort study

Endoscopic resection of advanced ampullary adenomas: a single-center 14-year retrospective cohort study

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

Study Protocol of the ESAP Study: Endoscopic Papillectomy vs. Surgical Ampullectomy vs. Pancreaticoduodenectomy for Ampullary Neoplasm—A Pancreas2000/EPC Study

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