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

Wiel, Sophia E. van der; Poley, Jan–Werner; Koch, Arjun D.; Bruno, Marco J.

doi:10.1007/s00464-018-6392-9

Cited by 33 publications

(37 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Delayed bleeding at a frequency in the range of 4–25% has been reported . Although there are no reports on which sites are most likely to bleed after EP, the frenulum area of the ampulla of Vater has a rich blood supply and is regarded as a frequent site of bleeding, as attested by our data shown in Figure .…”

Section: Discussionsupporting

confidence: 59%

See 1 more Smart Citation

Effect of preventive closure of the frenulum after endoscopic papillectomy: A prospective pilot study

Kagawa

Kubota

Kurita

et al. 2019

J of Gastro and Hepatol

View full text Add to dashboard Cite

Background and Aim The usefulness of preventive closure of the frenulum after endoscopic papillectomy (EP) could reduce bleeding. The feasibility and safety of clipping were evaluated in this prospective pilot study. Methods This study involved 40 consecutive patients who underwent preventive closure of the frenulum by clipping just after EP. The outcome data were compared with those of the previous 40 patients in whom no preemptive closure had been performed (no‐closure group) (UMIN000014783). Additionally, the bleeding sites were examined. Results The clipping procedure was successful in all patients. As compared to the no‐closure group, the rate of bleeding (P = 0.026) and period of hospital stay (P < 0.001) were significantly reduced in the closure group. There was no difference in the procedure time between the two groups. Furthermore, the incidence rates of pancreatitis and perforation were comparable in the two groups. The bleeding was noted in the frenulum area rather than at any other site in 90.9% of cases. Conclusion Preventive closure of the frenulum after EP is an effective, safe, rational, and economical method to reduce the incidence of delayed bleeding, without prolonging the procedure time or increasing the risk of post‐procedure pancreatitis perforation.

show abstract

Section: Discussionsupporting

confidence: 59%

“…However, the risk of bleeding could depend on the anatomical complexity and vascularity of the tumor site . Large tumors over 20 mm in diameter extending to frenulum tend to bleed and would need clipping . Some smaller tumors could also potentially bleed; therefore, preemptive closure for EP is expected to be beneficial.…”

Section: Discussionmentioning

confidence: 99%

Effect of preventive closure of the frenulum after endoscopic papillectomy: A prospective pilot study

Kagawa

Kubota

Kurita

et al. 2019

J of Gastro and Hepatol

View full text Add to dashboard Cite

show abstract

“…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

View full text Add to dashboard Cite

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.

show abstract

“…Although lateral spreading lesions showed higher rates of intraprocedural bleeding (50% vs. 24.7%) and delayed bleeding (25.0% vs. 12.3%), both groups of lesions had similar rates of histologically proven recurrence at the first surveillance (16.4% vs. 17.9%). In a retrospective cohort study, van der Wiel et al 8 compared the clinical outcomes of EP for lateral spreading/intraductal extending ade- Radiofrequency ablation nomas with those confined to the ampulla. A lateral spreading adenoma was defined as an adenoma that extended laterally >10 mm along the surface of the gastrointestinal tract, and it was removed in a piecemeal fashion.…”

Section: Lateral Spreading and Intraductal Lesionsmentioning

confidence: 99%

Management of Remnant or Recurrent Lesions after Endoscopic Papillectomy

et al. 2020

View full text Add to dashboard Cite

Endoscopic papillectomy (EP) for ampullary adenomas achieves cure rates ranging from 76% to 90%, and recurrence rates are as high as 33%. If remnant or recurrent lesions after prior EP are endoscopically visible and are not suspected of intraductal extension into the biliary or pancreatic duct, repeated snaring and cutting can be performed until all visible lesions are completely resected. However, endoscopic ablative therapies, particularly argon plasma coagulation, can be attempted for tiny or uncertain remnant and recurrent lesions. In addition, intraductal radiofrequency ablation has recently been attempted for residual intraductal lesions after EP at several institutions. Although still under investigation, it has shown some promise. It might be offered as an alternative to surgery, particularly in patients who are unfit for surgery or those who refuse to undergo surgery. Clin Endosc 2019 Dec 3. [Epub ahead of print]

show abstract

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

Abstract: Endoscopic ampullectomy is safe and highly successful in selected patients with an adenoma with or without lateral spreading. Outcomes of endoscopic treatment adenomas with an intraductal extension are less favorable and in these cases surgery should be considered.

Cited by 33 publications

References 34 publications

Effect of preventive closure of the frenulum after endoscopic papillectomy: A prospective pilot study

Effect of preventive closure of the frenulum after endoscopic papillectomy: A prospective pilot study

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

Management of Remnant or Recurrent Lesions after Endoscopic Papillectomy

Contact Info

Product

Resources

About