Endoscopic papillectomy of benign ampullary lesions: Outcomes from a multicenter study

Attila, Tan; Parlak, Erkan; Alper, Emrah; Dışıbeyaz, Selçuk; Çıçek, Bahattin; Ödemiş, Bülent

doi:10.5152/tjg.2018.17378

Cited by 24 publications

(31 citation statements)

References 41 publications

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“…1 The initial case series that reported the outcomes of endoscopic papillectomy were quite small and included favorable outcomes in benign lesions and lesions without intraductal growth [25,[78][79][80][81]. The results of subsequent studies included patients with adenocarcinoma (initially diagnosed with ampullary adenoma on preprocedural work-up but with adenocarcinoma revealed in post-procedural histology) with an adverse event rate similar to that in previous studies [21,37,[82][83][84][85][86][87].…”

Section: Recommendationmentioning

confidence: 98%

Endoscopic management of ampullary tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2021

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Main Recommendations 1 ESGE recommends against diagnostic/therapeutic papillectomy when adenoma is not proven.Strong recommendation, low quality evidence. 2 ESGE recommends endoscopic ultrasound and abdominal magnetic resonance cholangiopancreatography (MRCP) for staging of ampullary tumors.Strong recommendation, low quality evidence. 3 ESGE recommends endoscopic papillectomy in patients with ampullary adenoma without intraductal extension, because of good results regarding outcome (technical and clinical success, morbidity, and recurrence).Strong recommendation, moderate quality evidence. 4 ESGE recommends en bloc resection of ampullary adenomas up to 20–30 mm in diameter to achieve R0 resection, for optimizing the complete resection rate, providing optimal histopathology, and reduction of the recurrence rate after endoscopic papillectomy.Strong recommendation, low quality evidence. 5 ESGE suggests considering surgical treatment of ampullary adenomas when endoscopic resection is not feasible for technical reasons (e. g. diverticulum, size > 4 cm), and in the case of intraductal involvement (of > 20 mm). Surveillance thereafter is still mandatory.Weak recommendation, low quality evidence. 6 ESGE recommends direct snare resection without submucosal injection for endoscopic papillectomy.Strong recommendation, moderate quality evidence. 7 ESGE recommends prophylactic pancreatic duct stenting to reduce the risk of pancreatitis after endoscopic papillectomy.Strong recommendation, moderate quality evidence. 8 ESGE recommends long-term monitoring of patients after endoscopic papillectomy or surgical ampullectomy, based on duodenoscopy with biopsies of the scar and of any abnormal area, within the first 3 months, at 6 and 12 months, and thereafter yearly for at least 5 years.Strong recommendation, low quality evidence.

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Section: Recommendationmentioning

confidence: 98%

Endoscopic management of ampullary tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2021

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“…Pancreaticoduodenectomy has the advantage of low recurrence rate but has higher morbidity (25-65%) and mortality rates (1-10%) [2,5,[11][12][13][14][15]. By contrast, local surgical (transduodenal ampullectomy) or endoscopic resection has lower morbidity (0-25%) and mortality rates (0-1%) at the expense of higher recurrence rates (5-33%), necessitating postoperative endoscopic surveillance for the detection of residual or recurrent neoplastic tissue [2,5,12,13,[15][16][17][18][19][20][21][22]. Although the treatment has recently shifted toward minimally invasive endoscopic resection [10,15,[18][19][20][21][23][24][25], significant complications have been reported in up to 32% of patients, including acute pancreatitis, hemorrhage, perforation, cholangitis, and papillary stenosis [2, 15, 18-21, 23, 24].…”

Section: Introductionmentioning

confidence: 99%

“…The time frame for malignant transformation from low-grade dysplasia to advanced neoplasia (high-grade dysplasia or adenocarcinoma) is also uncertain, and thus there is no consensus regarding the most appropriate surveillance interval. This is further complicated by the high false-negative rate (9-60%) of endoscopic biopsy specimens in detecting high-grade dysplasia or adenocarcinoma when compared with final resection specimens, underscoring the limited accuracy of endoscopic biopsy [2,9,10,16,18,20,21,23,[25][26][27][28][29]. This is potentiated by significant histologic changes that can occur at the major papilla (due to marked inflammation, bile exposure, stones, or stents), which can limit accurate, reproducible histologic interpretation.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis, risk stratification, and management of ampullary dysplasia by DNA flow cytometric analysis of paraffin-embedded tissue

et al. 2019

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The limited accuracy of endoscopic biopsy in detecting high-grade dysplasia or adenocarcinoma within ampullary adenoma or dysplasia has been reported. The natural history of ampullary dysplasia is also unclear, and there are no established guidelines to determine which patients with ampullary dysplasia require resection versus surveillance endoscopy. DNA flow cytometry was performed on 47 ampullary biopsies with low-grade dysplasia, 18 high-grade dysplasia, and 23 negative for dysplasia, as well as 11 cases of ampullary adenocarcinoma. Abnormal DNA content (aneuploidy or elevated 4N fraction > 6%) was identified in 9 (82%) of adenocarcinoma, 13 (72%) of high-grade dysplasia, 7 (15%) of low-grade dysplasia, and none (0%) of non-dysplastic mucosa. One-, 2-, and 7-year detection rates of high-grade dysplasia or adenocarcinoma in low-grade dysplasia patients with abnormal DNA content were 57%, 86%, and 88%, respectively, whereas low-grade dysplasia patients in the setting of normal DNA content had 1-, 2-, and 7-year detection rates of 10%, 10%, and 10%, respectively. The univariate and multivariate hazard ratios (HRs) for subsequent detection of high-grade dysplasia or adenocarcinoma in low-grade dysplasia patients with DNA content abnormality were 16.8 (p = <0.01) and 9.8 (p = <0.01), respectively. Among the 13 high-grade dysplasia patients with DNA content abnormality, 5 patients (38%) were subsequently found to have adenocarcinoma within a mean follow-up time of 3 months, whereas only 1 (20%) of the remaining 5 patients in the setting of normal DNA content developed adenocarcinoma in a month (HR = 2.6, p = 0.39). The overall 1-and 2-year detection rates of adenocarcinoma in all high-grade dysplasia patients (regardless of flow cytometric results) were 34% (95% confidence interval = 16-63%) and 47% (95% confidence interval = 23-79%), respectively. In conclusion, the majority of low-grade dysplasia patients (86%) in the setting of abnormal DNA content developed high-grade dysplasia or adenocarcinoma within 2 years and thus may benefit from resection, whereas those with normal DNA content may be followed with surveillance endoscopy. The presence of DNA content abnormality can also confirm a morphologic suspicion of high-grade dysplasia, which should be managed with resection, as nearly 50% of the high-grade dysplasia patients were found to have adenocarcinoma within 2 years.

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“…Histomorphologisch unterscheidet man wie im Intestinaltrakt tubuläre, villöse oder tubulovillöse Wachstumsformen mit geringgradiger oder hochgradiger intraepithelialer Neoplasie [6,10]. Andere seltene benigne periampulläre Tumoren sind Adenofibrome, Hamartome, die Hyperplasie der Brunner-Drüsen (Glandulae duodenales), Lymphome sowie Ganglioneurome [11].…”

Section: Sonstigeunclassified

Periampulläre Tumoren: Epidemiologie, Klassifikation und Diagnostik

Herzog¹,

Uhl²

2021

Onkologie up2date

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Endoscopic papillectomy of benign ampullary lesions: Outcomes from a multicenter study

Cited by 24 publications

References 41 publications

Endoscopic management of ampullary tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Endoscopic management of ampullary tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Diagnosis, risk stratification, and management of ampullary dysplasia by DNA flow cytometric analysis of paraffin-embedded tissue

Periampulläre Tumoren: Epidemiologie, Klassifikation und Diagnostik

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