Radiofrequency ablation for intraductal extension of ampullary neoplasms

Rustagi, Tarun; Irani, Shayan; Reddy, D. Nageshwar; Dayyeh, Barham K. Abu; Baron, Todd H.; Gostout, Christopher J.; Levy, Michael J.; Martin, John A.; Petersen, Bret T.; Ross, Andrew; Topazian, Mark D.

doi:10.1016/j.gie.2016.11.002

Cited by 71 publications

(77 citation statements)

References 29 publications

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“…Ideally, after appropriate ampullary resection and sphincterotomy, the intraductal extension of the adenomatous lesion is exposed, visually inspected, and removed. The role of radiofrequency ablation to treat intraductal extension of ampullary adenomas is currently under investigation and shows some promise [27, 28]. Needless to state that adequate follow-up is pivotal importance in order to timely revert to surgical resection not losing out on an opportunity for curative treatment.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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“…Endoscopic therapy by standard or over-thescope clips to close the perforation was successfully carried out in all cases, with no need of surgery and a satisfactory clinical evolution. The median length of hospitalization in these patients was 7 days (range: [3][4][5][6][7][8][9][10][11][12][13][14][15].…”

Section: Patientsmentioning

confidence: 99%

Combined excision and ablation of ampullary tumors with biliary or pancreatic intraductal extension is effective even in malignant neoplasms

Pérez-Cuadrado-Robles

Piessevaux

Moreels

et al. 2019

UEG Journal

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Background: The feasibility and outcome of endoscopic resection in ampullary tumors with intraductal growth remains unclear. Objective: To assess the safety, feasibility and outcomes of these patients treated by thermal ablation. Methods: Retrospective observational study. All consecutive patients who underwent an endoscopic snare papillectomy with a 6-month minimum follow-up were included. Ablation was performed with cystotomes and soft/forced coagulation. Successful endoscopic treatment was defined as no adenomatous residual tissue or recurrence observed at follow-up. Results: Of 86 patients presenting with an ampullary tumor, 73 (58 AE 14 years old, 49% men, 34% familial adenomatous polyposis) (median tumor size: 20 mm, range: 8-80) were included. En bloc and curative resection rates were achieved in 46.6% and 83.6%, respectively. Intraductal ingrowth was seen in 18 (24.7%) patients and histologically confirmed in 12 (16.4%). Intraductal ablation achieved a 100% success rate, with a 20-month median follow-up. Most of these patients had malignant forms (n ¼ 8, 66.7%), with a higher adenocarcinoma rate (33.3% versus 3.3%, p ¼ 0.001) compared to extraductal tumors. Overall, there was a 20.5% complication rate with no significant differences between both groups (p ¼ 0.676). Conclusions: Intraductal ablation achieves a high therapeutic success rate in ampullary tumors with 20 mm ductal extension, even in malignant forms or biliary and pancreatic involvement. The technique is feasible, cheap and safe and may avoid major surgery. Key summary1. Summary of the established knowledge on this subject . Endoscopic papillectomy can offer a curative resection in 67-92% of cases.. Intraductal extension has been described as a relative contraindication for endoscopic resection and is associated with lower curative resection rates and incomplete adenoma removal. . There is no consensus on the indications for endoscopic papillectomy in intraductal extension of ampullary neoplasms and the maximum intraductal involvement able to be resected endoscopically is unknown.

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“…Recently, a retrospective multicenter study evaluated the feasibility, safety, and efficacy of endoscopic RFA for ampullary neoplasms with intraductal extension. 61 In this study, a total of 14 patients with adenoma extension into the common bile duct (13 AE 7 mm; n ¼ 14) and pancreatic duct (7 AE 2 mm; n ¼ 3) were treated with a RFA catheter. With treatment failure documented and persistent tumor invasion shown histologically, these patients underwent a median of 1 RFA session (range, 1-5 sessions).…”

Section: Intraductal Extension Of Ampullary Adenomamentioning

confidence: 99%

New Indications for Endoscopic Radiofrequency Ablation

McCarty

Rustagi

2018

Clinical Gastroenterology and Hepatology

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Radiofrequency ablation (RFA) is a well-established treatment for several benign, premalignant, and malignant disorders. Although the role of RFA has been clearly defined, new indications for luminal and extraluminal applications of endoscopic RFA-directed therapies have emerged. RFA has recently produced promising results in patients with a variety of gastrointestinal and hepatopancreatobiliary pathologies. For example, endoscopic RFA has been used to treat patients with gastric antral vascular ectasia, chronic radiation proctitis, malignant biliary strictures, and ampullary adenomas with intraductal extension. Furthermore, endoscopic ultrasound-guided RFA appears to be an effective, minimally invasive treatment for ablation of solid and cystic lesions-particularly in the pancreas. We review the newer indications for RFA and discuss potential limitations of endoscopic RFA.

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Radiofrequency ablation for intraductal extension of ampullary neoplasms

Cited by 71 publications

References 29 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

Combined excision and ablation of ampullary tumors with biliary or pancreatic intraductal extension is effective even in malignant neoplasms

New Indications for Endoscopic Radiofrequency Ablation

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