Treatment Options for Villous Adenoma of the Ampulla of Vater

Abstract

Introduction: Duodenal villous adenoma arising from the ampulla of Vater has a high risk of malignant development. Excluding associated malignant disease prior to resection of an adenoma of the ampulla is not always possible. Therefore, the surgical procedure of choice to treat this rare tumour is still controversial. Objective: To evaluate retrospectively results of treatment of villous adenoma arising from ampulla of Vater with dysplasia or associated carcinoma limited to the ampulla. Patients and Methods: From 1985 to 1996, eight patients have been diagnosed with ampullary villous adenoma suitable for resection. We have reviewed treatment, morbidity, mortality, follow-up and final outcome. Results: Pancreatoduodenectomy (PD) was performed in 4 patients. Transduodenal ampullectomy and endoscopic resection was performed in 2 patients each. There was no perioperative mortality. None of the patients had biliary, pancreatic or intestinal leakage but two patients who underwent PD had minor postoperative complications. The mean follow-up was 44 (range: 6–132) months. Villous adenoma was associated with adenocarcinoma in 50% of the cases (4/8 patients). During the followup both patients who underwent transduodenal ampullectomy developed recurrent disease. All patients initially treated by PD are alive without evidence of recurrent disease. Conclusions: Treatment of villous adenoma of the ampulla must be individualized within certain limits. In our series, PD achieve good results and it appears to be the procedure of choice in order to treat villous adenomas with proved presence of carcinoma, carcinoma in situ or severe dysplasia. Endoscopic or local resection may be appropriate for small benign tumours in high risk patients.

Giant laterally spreading tumors of the papilla: endoscopic features, resection technique, and outcome (with videos)

“…[24][25][26][27][28][29] A further noticeable result in the current LST-P resection series of mainly elderly patients is the reduced overnight hospital stay (median 1 night) compared with the expected median hospital stay of 5 days for local surgical resections and as long as 3 weeks for radical surgical resection. [24][25][26][27][28][29] With meticulous staging and resection technique, even in a mainly elderly population, the single-session combination EMR and papillectomy is a viable option for giant LST-P. Our data show that this approach is safe and effective. It should be considered as an alternative tertiary referral endoscopic treatment in preference to surgery, especially in patients with significant comorbidity.…”

Ampullary Tumors: Endoscopic Versus Operative Management

“…Pancreaticoduodenectomy is a procedure of choice for frank carcinoma, foci of papillary adenocarcinoma in pre-excisional biopsies, or high-grade dysplasia in ampullary adenomas. Some authors 31 note that pancreaticoduodenectomy should be indicated initially for ampullary adenomas with severe dysplasia.…”

Ampulla of Vater Cancer with Cholangitis and Pancreatitis

“…Villous adenomas can be associated with an adenocarcinoma and a histological diagnosis of an adenoma does not exclude the presence of an adenocarcinoma elsewhere in the tumour. [13][14][15][16]. In our patients endoscopic biopsies were diagnostic for an adenocarcinoma in 13/17 cases (76%).…”