Endoscopic versus surgical treatment of ampullary adenomas: a systematic review and meta-analysis

Abstract

The aim of this study is to address the outcomes of endoscopic resection compared with surgery in the treatment of ampullary adenomas.A systematic review and meta-analysis were performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. For this purpose, the Medline, Embase, Cochrane, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scopus and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were scanned. Studies included patients with ampullary adenomas and data considering endoscopic treatment compared with surgery. The entire analysis was based on a fixed-effects model.Five retrospective cohort studies were selected (466 patients). All five studies (466 patients) had complete primary resection data available and showed a difference that favored surgical treatment (risk difference [RD] = -0.24, 95% confidence interval [CI] = -0.44 to -0.04). Primary success data were identified in all five studies as well. Analysis showed that the surgical approach outperformed endoscopic treatment for this outcome (RD = -0.37, 95% CI = -0.50 to -0.24). Recurrence data were found in all studies (466 patients), with a benefit indicated for surgical treatment (RD = 0.10, 95% CI = -0.01 to 0.19). Three studies (252 patients) presented complication data, but analysis showed no difference between the approaches for this parameter (RD = -0.15, 95% CI = -0.53 to 0.23).Considering complete primary resection, primary success and recurrence outcomes, the surgical approach achieves significantly better results. Regarding complication data, this systematic review concludes that rates are not significantly different.

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

“…The treatment options for ampullary dysplasia include surgical (pancreaticoduodenectomy [Whipple procedure] or transduodenal ampullectomy) and endoscopic resection. 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].…”

Endoscopic Papillectomy for Early Ampullary Neoplastic Lesions - A Case Series Analysis

“…Although there is no consensus on which adenomas should be monitored or resected by surgical or endoscopic approach, EP is recommended in tubular, tubulevillous or villous adenomas in the presence of HGD (4) . Local surgical excision (surgical ampullectomy) is associated with higher rates of complete resection, clinical success and lower recurrence when compared to endoscopic resection (11) . In the largest comparative series (case-control) published so far, involving 180 patients undergoing endoscopic technique (130 patients) versus surgery for local excision of adenomas of the Vater papilla, the clinical results were similar.…”

Severe necrotizing pancreatitis after endoscopic papillectomy in a patient with ampullary adenoma

“…Post-papillectomy pancreatitis is the most common complication with a reported incidence of 8% to 15%. 2 While the rate of severe post-papillectomy pancreatitis was unknown exactly, approximately 15% to 25% of patients with acute pancreatitis develop severe pancreatitis accompanying with organ dysfunction. 3 Therefore, prophylactic pancreatic duct stent placement and rectal indomethacin are recommended during papillectomy.…”