Paolo Cecinato1, Francesca Parmeggiani2, Luca Braglia3, Gabriele Carlinfante4, Ramona Zecchini2, Francesco Decembrino2, Veronica Iori2, Giuliana Sereni2, Cristiana Tioli2, Maurizio Cavina2, Lorenzo Camellini5, Francesco Azzolini6, Maurizio Ponz de Leon7, Romano Sassatelli2. 1. Unit of Gastroenterology and Digestive Endoscopy, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy. paolo.cecinato@ausl.re.it. 2. Unit of Gastroenterology and Digestive Endoscopy, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy. 3. Research and Statistics Infrastructure, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy. 4. Unit of Pathology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy. 5. Unit of Gastroenterology, ASL 5 Spezzino, La Spezia, Italy. 6. Division of Gastroenterology and Gastrointestinal Endoscopy, Vita Salute San Raffaele University, Milan, Italy. 7. Diagnostic Medicine Department, Clinic and Public Health, University of Modena and Reggio Emilia, Modena, Italy.
Abstract
BACKGROUND: Ampullary adenomas are rare and potentially malignant. Surgery was the standard treatment but endoscopic papillectomy (EP) is a possible alternative. AIM: We retrospectively evaluated the principal clinical outcomes of EP in all patients referred to our unit also dividing sporadic ampullary adenoma (SAA) from familial adenomatous polyposis (FAP)-associated adenomas. METHODS: All consecutive patients who underwent endoscopic papillectomy because of ampullary adenoma were considered. The primary outcome was the technical success of EP. Secondary outcomes included the number of procedures, the adverse event rate, the recurrence rate, the concordance of histology pre- and post-EP, and the evaluation of factors related to technical success. RESULTS: Between January 2001 and December 2015, sixty-two patients were included (21 FAP and 41 SAA). Technical success was achieved in 75.8% and was different in the two groups (FAP 95.2%, SAA 65.8%, p 0.025). Intraductal invasion was negatively associated with technical success (41.7% vs. 84.0%; p 0.005). The intestinal subtype was predictive of success (79.7% vs. 0%; p 0.012) as well as en bloc resection (90.3% vs. 61.3%; p 0.016). Adverse events were reported in 14 patients (22.6%). CONCLUSIONS: EP is an effective and safe procedure and is a viable alternative to surgery. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03494543.
BACKGROUND: Ampullary adenomas are rare and potentially malignant. Surgery was the standard treatment but endoscopic papillectomy (EP) is a possible alternative. AIM: We retrospectively evaluated the principal clinical outcomes of EP in all patients referred to our unit also dividing sporadic ampullary adenoma (SAA) from familial adenomatous polyposis (FAP)-associated adenomas. METHODS: All consecutive patients who underwent endoscopic papillectomy because of ampullary adenoma were considered. The primary outcome was the technical success of EP. Secondary outcomes included the number of procedures, the adverse event rate, the recurrence rate, the concordance of histology pre- and post-EP, and the evaluation of factors related to technical success. RESULTS: Between January 2001 and December 2015, sixty-two patients were included (21 FAP and 41 SAA). Technical success was achieved in 75.8% and was different in the two groups (FAP 95.2%, SAA 65.8%, p 0.025). Intraductal invasion was negatively associated with technical success (41.7% vs. 84.0%; p 0.005). The intestinal subtype was predictive of success (79.7% vs. 0%; p 0.012) as well as en bloc resection (90.3% vs. 61.3%; p 0.016). Adverse events were reported in 14 patients (22.6%). CONCLUSIONS: EP is an effective and safe procedure and is a viable alternative to surgery. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03494543.
Authors: William K Hirota; Marc J Zuckerman; Douglas G Adler; Raquel E Davila; James Egan; Jonathan A Leighton; Waqar A Qureshi; Elizabeth Rajan; Robert Fanelli; Jo Wheeler-Harbaugh; Todd H Baron; Douglas O Faigel Journal: Gastrointest Endosc Date: 2006-04 Impact factor: 9.427
Authors: A Scarpa; P Capelli; G Zamboni; T Oda; K Mukai; F Bonetti; G Martignoni; C Iacono; G Serio; S Hirohashi Journal: Am J Pathol Date: 1993-04 Impact factor: 4.307