M Vogt1, R Jakobs, C Benz, J C Arnold, H E Adamek, J F Riemann. 1. Department of Medicine C, Klinikum der Stadt Ludwigshafen gGmbH, Academic Teaching Hospital of the Johannes Gutenberg University of Mainz, Germany. MedCLu@t-online.de
Abstract
AIMS: To compare the efficacy and the complication rate between endoscopic snare resection of adenomas of Vater's papilla and endoscopic palliation. METHODS: In a retrospective, non randomized manner, we compared long-term results of our endoscopic strategies in 36 patients with histologically confirmed adenoma of Vater's papilla submitted either to local endoscopic snare resection (n=18) or to simple endoscopic palliation (n= 18), respectively. RESULTS: Between 1985 and 1998 results were reviewed. Median age was 76.5 (range 42-89) years in the palliation, and 64.0 (23-89) years in the endoscopic snare resection group. Median duration of follow-up was 33 (6-135) and 75.0 (27-123) months, respectively. The incidence of adenocarcinoma of Vater's papilla was 1 per 52.8 patient-years after endoscopic snare resection and 1 per 15.5 patient-years in the group treated with endoscopic palliation. Compared to the results of endoscopic palliation (prosthesis, sphincterotomy), we found a significant reduction of carcinoma-related death (p=0.0045, McNemar) and adenoma carcinoma-sequence (p=0.007, McNemar) after snare resection. CONCLUSIONS: This retrospective study suggests that complete endoscopic snare resection of adenomas of Vater's papilla will lead to a lower rate of adenoma-carcinoma sequence, to a lower carcinoma-related death rate and probably improves patient survival. These results should be proven prospectively.
AIMS: To compare the efficacy and the complication rate between endoscopic snare resection of adenomas of Vater's papilla and endoscopic palliation. METHODS: In a retrospective, non randomized manner, we compared long-term results of our endoscopic strategies in 36 patients with histologically confirmed adenoma of Vater's papilla submitted either to local endoscopic snare resection (n=18) or to simple endoscopic palliation (n= 18), respectively. RESULTS: Between 1985 and 1998 results were reviewed. Median age was 76.5 (range 42-89) years in the palliation, and 64.0 (23-89) years in the endoscopic snare resection group. Median duration of follow-up was 33 (6-135) and 75.0 (27-123) months, respectively. The incidence of adenocarcinoma of Vater's papilla was 1 per 52.8 patient-years after endoscopic snare resection and 1 per 15.5 patient-years in the group treated with endoscopic palliation. Compared to the results of endoscopic palliation (prosthesis, sphincterotomy), we found a significant reduction of carcinoma-related death (p=0.0045, McNemar) and adenoma carcinoma-sequence (p=0.007, McNemar) after snare resection. CONCLUSIONS: This retrospective study suggests that complete endoscopic snare resection of adenomas of Vater's papilla will lead to a lower rate of adenoma-carcinoma sequence, to a lower carcinoma-related death rate and probably improves patient survival. These results should be proven prospectively.
Authors: Wim Laleman; Annelies Verreth; Baki Topal; Raymond Aerts; Mina Komuta; Tania Roskams; Schalk Van der Merwe; David Cassiman; Frederik Nevens; Chris Verslype; Werner Van Steenbergen Journal: Surg Endosc Date: 2013-05-25 Impact factor: 4.584
Authors: Enrique Pérez-Cuadrado-Robles; Hubert Piessevaux; Tom G Moreels; Ralph Yeung; Tarik Aouattah; Mina Komuta; Hélène Dano; Anne Jouret-Mourin; Pierre H Deprez Journal: United European Gastroenterol J Date: 2019-01-12 Impact factor: 4.623