Endoscopic Snare Papillectomy in Patients with Familial Adenomatous Polyposis and Ampullary Adenoma

Bertoni, G.; Sassatelli, R.; Nigrisoli, Evandro; Bedogni, G.

doi:10.1055/s-2007-1004281

Cited by 45 publications

(23 citation statements)

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“…The aim with a biliar or pancreatic sphincterotomy and placement of a stent is to enhance the technical success and decrease the complications of endoscopic ampullectomy (4,13,48,(57)(58)(59). However, a preresection sphincterotomy has some drawbacks.…”

Section: Sphincterotomy and Stent Placementmentioning

confidence: 99%

Endoscopic ampullectomy: A technical review

Espinel¹,

Pinedo²,

Ojeda³

et al. 2015

Rev Esp Enferm Dig

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Background and aim:This article provides a practical review to undertaking safe endoscopic ampullectomy and highlights some of the common difficulties with this technique as well as offering strategies to deal with these challenges.Methods: We conducted a review of studies regarding endoscopic ampullectomy for ampullary neoplasms with special focus on techniques.Results: Accurate preoperative diagnosis and staging of ampullary tumors is imperative for predicting prognosis and determining the most appropriate therapeutic approach. The optimal technique for endoscopic ampullectomy is dependent on the lesions size. En bloc resection is recommended for lesions confined to the papilla. There is no significant evidence to support the submucosal injection before ampullectomy. There is no consensus regarding the optimal current and power output for endoscopic ampulectomy. The benefits of a thermal adjunctive therapy remain controversial. A prophylactic pancreatic stent reduces the incidence and severity of pancreatitis post-ampullectomy.Conclusions: Endoscopic ampullectomy is a safe and efficacious therapeutic procedure for papillary adenomas in experienced endoscopist and it can avoid the need for surgical intervention.

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Section: Sphincterotomy and Stent Placementmentioning

confidence: 99%

Endoscopic ampullectomy: A technical review

Espinel¹,

Pinedo²,

Ojeda³

et al. 2015

Rev Esp Enferm Dig

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“…Ampullary adenoma represents the precursor lesion to adenocarcinoma, and a coexistent adenoma can be identified frequently in patients with ampullary adenocarcinoma (1, 2). Because of their premalignant nature, ampullary adenomas are often resected either by polypectomy or, in the case of larger lesions, by pancreaticoduodenectomy (1,4,5). An association between adenomas of the ampullary region and pancreatic intraductal neoplasia has not been documented previously.…”

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confidence: 99%

Neoplasms of the Ampulla of Vater with Concurrent Pancreatic Intraductal Neoplasia: A Histological and Molecular Study

et al. 2001

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Adenoma and adenocarcinoma of the ampulla of Vater are uncommon neoplasms of the gastrointestinal tract that are found with increased frequency in familial adenomatous polyposis syndrome (1-3). Ampullary adenoma represents the precursor lesion to adenocarcinoma, and a coexistent adenoma can be identified frequently in patients with ampullary adenocarcinoma (1, 2). Because of their premalignant nature, ampullary adenomas are often resected either by polypectomy or, in the case of larger lesions, by pancreaticoduodenectomy (1,4,5). An association between adenomas of the ampullary region and pancreatic intraductal neoplasia has not been documented previously. Adenocarcinoma of the pancreas is often associated with pancreatic intraductal neoplasia (PanIN), which is thought to represent the precursor lesion for this cancer (6 -12). Several case reports documenting progression of high-grade (HG) PanIN to invasive pancreatic adenocarcinoma over time (17 mo to 29 y) support the role of PanIN as a precursor of carcinoma (10,13,14).The relationship between ampullary adenoma and PanIN has not been investigated previously, and only one analysis of the relationship between

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“…Diagnostic papillectomy (or papillotomy in selected cases) including deep biopsy is recommended if there are an infi ltrating tumor growth revealed by EUS and negative fi ndings in the initial histologic investigation. Unlike laser or thermal ablation, papillectomy allows complete histologic investigation of the pathologic tissue (Bertoni et al 1997). However, decision-making for a minimally invasive endoscopic approach is infl uenced by the spectrum and risk of possible complications such as perforation or bleeding.…”

Section: Discussionmentioning

confidence: 99%

Indications and Outcome of Endoscopic Papillectomy of the Major and Minor Papilla—a Prospective 5-year Study

Will¹,

Gottschalk

Bosseckert³

et al. 2009

Clinical Medicine. Gastroenterology

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Endoscopic papillectomy is a promising and challenging endoscopic intervention. The aim of this study was i) to classify the differential indication, and ii) to study the outcome in papillectomy of suspicious tumor lesions of the papilla of Vater (papilla).Methods: Thirty nine patients were enrolled (22 males/17 females; range of age, 21-88 years) who underwent endoscopic papillectomy because of a polypoid tumor at the papilla revealed by previous endoscopic ultrasonography (EUS) over a time period of 5 years. Follow-up EUS and histologic investigation were performed within 28 days(d).Results: I) All tumors were detectable using EUS (range of tumor size, 1-4.5 cm). II) Indications, histologic diagnoses and their distribution were as follows: Group(Gr.)1 (n = 21): Adenoma (n = 18), uT1 carcinoma(Ca) of high risk patients (n = 3) with R0 resection (n = 17) vs. R1 (n = 4; all reapproached using argon beamer). On the 28th postinterventional d, all subjects were free of tumor. Recurrent tumor growth was found in 3 cases after 6, 18 and 26 months respectively (range of endoscopic follow up [n = 14], 3-60 months). Three patients (free of tumor) died from other causes after 3, 8 and 18 months, respectively. Gr. 2 (n = 8): Contradiction between EUS (infi ltrating tumor growth) and histologic fi nding (adenoma or unspecifi c infl ammation); histological fi ndings were: Adenomyomatosis of the papilla (n = 5), infi ltrating Ca of the papilla or peripapillary region (n = 3). Gr. 3 (n = 4): Neuroendocrine tumors of the major (n = 2) or minor papilla (n = 2): 2 benign, 1 Ca and 1 carcinoid tumor. Gr. 4 (n = 6): Non-introducible catheter through the minor papilla in case of suspected pancreas divisum (n = 2) or through the major papilla (n = 1) after previous gastric resection (Billroth II) or because of Ca of the papilla with no successful attempts to drain the bile duct (n = 3): Catheter insertion was achieved after papillectomy (n = 3) or partial tumor resection (n = 3). III) Complications: 8 of 39 patients (20.5%) developed postinterventional pancreatitis (severe course, n = 1); in 7 cases, bleeding occurred, no perforation was seen. The rate of recurrent tumor growth after R0 resection was 17.6% (3 of 17 subjects).In summary, papillectomy is feasible in the case of i) polypoid tumor of the papilla, ii) infi ltrating tumor growth revealed by EUS and negative histologic investigation (optional: plus deep biopsy), and iii) tumor lesion, through which catheter can not be placed to get access to the pancreatobiliary system.In conclusion, endoscopic papillectomy fulfi lls diagnostic as well as therapeutic requirements and can be recommended as minimally invasive but appropriate method for well-defi ned indications of papillary tumor lesions.

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Endoscopic Snare Papillectomy in Patients with Familial Adenomatous Polyposis and Ampullary Adenoma

Cited by 45 publications

References 0 publications

Endoscopic ampullectomy: A technical review

Endoscopic ampullectomy: A technical review

Neoplasms of the Ampulla of Vater with Concurrent Pancreatic Intraductal Neoplasia: A Histological and Molecular Study

Indications and Outcome of Endoscopic Papillectomy of the Major and Minor Papilla—a Prospective 5-year Study

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