Andrea Tringali1, Giorgio Valerii2, Ivo Boškoski3, Pietro Familiari3, Rosario Landi4, Vincenzo Perri3, Guido Costamagna3. 1. Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia. Digestive Endoscopy Unit.; Università Cattolica del Sacro Cuore, Roma, Italia. Centre for Endoscopic Research Therapeutics and Training (CERTT).. Electronic address: andrea.tringali@unicatt.it. 2. Università Cattolica del Sacro Cuore, Roma, Italia. Centre for Endoscopic Research Therapeutics and Training (CERTT). 3. Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia. Digestive Endoscopy Unit.; Università Cattolica del Sacro Cuore, Roma, Italia. Centre for Endoscopic Research Therapeutics and Training (CERTT). 4. Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia. Digestive Endoscopy Unit.
Abstract
BACKGROUND: The premalignant nature of ampullary adenomas justifies their radical excision. AIMS: Aim of this study is to evaluate the long-term results of endoscopic snare papillectomy in a consecutive series of patients with ampullary adenomas. METHODS: Patients who underwent endoscopic snare papillectomy between October 1999 and October 2017 were identified from an electronic database. Endoscopic snare papillectomy was performed en bloc, when possible; a pancreatic stent or a nasopancreatic drainage were inserted. Endoscopic follow-up was scheduled after 3, 6 and 12 months for the first year, then yearly. RESULTS: Endoscopic snare papillectomy was performed in 135 patients (70 M, mean age 60.5 years) by en bloc (83%) or piecemeal (17%) resection. Delayed bleeding occurred in 16 patients (11.8%), infected retroperitoneal collections in 6 patients (4.4%), pancreatitis in 4 patients (3%). One patient died (0.7%). Follow-up was available in 103/114 (90.3%) patients. In case of residual (24.3%) and recurrent (23.3%), adenomas endoscopic retreatment was successful in 42/49 cases (85.7%). After a mean follow-up of 40 months, 93.2% (96/103) of the patients were disease free CONCLUSION: Endoscopic snare papillectomy of ampullary adenomas is effective with favorable long-term outcomes. Compliance to the scheduled follow-up is important for the early detection and re-treatment of recurrences.
BACKGROUND: The premalignant nature of ampullary adenomas justifies their radical excision. AIMS: Aim of this study is to evaluate the long-term results of endoscopic snare papillectomy in a consecutive series of patients with ampullary adenomas. METHODS:Patients who underwent endoscopic snare papillectomy between October 1999 and October 2017 were identified from an electronic database. Endoscopic snare papillectomy was performed en bloc, when possible; a pancreatic stent or a nasopancreatic drainage were inserted. Endoscopic follow-up was scheduled after 3, 6 and 12 months for the first year, then yearly. RESULTS: Endoscopic snare papillectomy was performed in 135 patients (70 M, mean age 60.5 years) by en bloc (83%) or piecemeal (17%) resection. Delayed bleeding occurred in 16 patients (11.8%), infected retroperitoneal collections in 6 patients (4.4%), pancreatitis in 4 patients (3%). One patient died (0.7%). Follow-up was available in 103/114 (90.3%) patients. In case of residual (24.3%) and recurrent (23.3%), adenomas endoscopic retreatment was successful in 42/49 cases (85.7%). After a mean follow-up of 40 months, 93.2% (96/103) of the patients were disease free CONCLUSION: Endoscopic snare papillectomy of ampullary adenomas is effective with favorable long-term outcomes. Compliance to the scheduled follow-up is important for the early detection and re-treatment of recurrences.