Endoscopic papillectomy in treatment of patients with ampullary neoplasms: a single-center experience

Abstract

Introduction: Benign tumors of the ampulla of Vater occur in 0.4% -0.12% of all tumors of the gastrointestinal tract (GI tract). However, malignant transformation occurs in 60-65% of cases, so the common tactic of treatment is their removal. Regardless of the pathophysiological structure of the tumor, endoscopic papillectomy is considered reasonably safe and most effective method compared to a more radical interventions such as pancreatoduodenal resection (PDR), transduodenal resection. Material and methods: 37 endoscopic papillectomies were performed at the Moscow Clinical Research Center between April 2014 and January 2018. In most cases, the tumor was detected during a routine examination for other diseases. The preoperative examination protocol included duodenoscopy with biopsy, endosonography, CT or MRI, which excluded the presence of malignant lesions and the intraductal spread of the adenoma more than 1 cm. The sizes of the adenomas ranged from 1 cm to 5 cm. The aim of the study was to evaluate the effectiveness of endoscopic papillectomy in the treatment of patients with neoplasm of the ampulla of Vater. Results: 37 patients underwent endoscopic papillectomy, including 16 men and 21 women. Median age: 54 years (26-73). The average time of surgery was 85 minutes. In 26 cases, the removal of the adenoma was performed "en bloc" (59.5%). In 11 cases, due to the presence of lateral spread of the tumor, fragmentation was performed (40.5%). Pancreatic stenting was successful in 31 patients (83.7%). Stenting of the common bile duct in 9 patients (24.3%). In all cases there was R0 resection. Morbidity included bleeding in 8 patients (21.6%), 2 cases of intraoperative perforation (5.4%), one of them was conservatively treated. The other was operated in volume: laparotomy, suturing a perforation, drainage of the abdominal cavity. In 2 patients, the postoperative period was complicated by cicatricial stenosis of the bile duct opening (5.4%). The ERCP with the stenting of the common bile duct was performed. No death occurred. Conclusions: Endoscopic papillectomy is characterized by lower morbidity and mortality and a shorter period of hospitalization. Compared with surgery, endoscopic ampullectomy appears to be a preferred treatment modality for small benign ampullary tumors with high success rate of tumor eradication.