Combined excision and ablation of ampullary tumors with biliary or pancreatic intraductal extension is effective even in malignant neoplasms.
Adult
Aged
Ampulla of Vater
/ pathology
Common Bile Duct Neoplasms
/ surgery
Cystotomy
/ instrumentation
Electrocoagulation
/ adverse effects
Feasibility Studies
Female
Follow-Up Studies
Humans
Male
Middle Aged
Neoplasm Recurrence, Local
/ prevention & control
Pancreatic Intraductal Neoplasms
/ surgery
Retrospective Studies
Sphincterotomy, Endoscopic
/ adverse effects
Treatment Outcome
Ampullary tumor
ERCP
ampullectomy
cystotome
papillectomy
thermal ablation
Journal
United European gastroenterology journal
ISSN: 2050-6406
Titre abrégé: United European Gastroenterol J
Pays: England
ID NLM: 101606807
Informations de publication
Date de publication:
04 2019
04 2019
Historique:
received:
25
08
2018
accepted:
09
11
2018
entrez:
26
4
2019
pubmed:
26
4
2019
medline:
26
4
2019
Statut:
ppublish
Résumé
The feasibility and outcome of endoscopic resection in ampullary tumors with intraductal growth remains unclear. To assess the safety, feasibility and outcomes of these patients treated by thermal ablation. Retrospective observational study. All consecutive patients who underwent an endoscopic snare papillectomy with a 6-month minimum follow-up were included. Ablation was performed with cystotomes and soft/forced coagulation. Successful endoscopic treatment was defined as no adenomatous residual tissue or recurrence observed at follow-up. Of 86 patients presenting with an ampullary tumor, 73 (58 ± 14 years old, 49% men, 34% familial adenomatous polyposis) (median tumor size: 20 mm, range: 8-80) were included. En bloc and curative resection rates were achieved in 46.6% and 83.6%, respectively.Intraductal ingrowth was seen in 18 (24.7%) patients and histologically confirmed in 12 (16.4%). Intraductal ablation achieved a 100% success rate, with a 20-month median follow-up. Most of these patients had malignant forms ( Intraductal ablation achieves a high therapeutic success rate in ampullary tumors with ≤20 mm ductal extension, even in malignant forms or biliary and pancreatic involvement. The technique is feasible, cheap and safe and may avoid major surgery.
Sections du résumé
Background
The feasibility and outcome of endoscopic resection in ampullary tumors with intraductal growth remains unclear.
Objective
To assess the safety, feasibility and outcomes of these patients treated by thermal ablation.
Methods
Retrospective observational study. All consecutive patients who underwent an endoscopic snare papillectomy with a 6-month minimum follow-up were included. Ablation was performed with cystotomes and soft/forced coagulation. Successful endoscopic treatment was defined as no adenomatous residual tissue or recurrence observed at follow-up.
Results
Of 86 patients presenting with an ampullary tumor, 73 (58 ± 14 years old, 49% men, 34% familial adenomatous polyposis) (median tumor size: 20 mm, range: 8-80) were included. En bloc and curative resection rates were achieved in 46.6% and 83.6%, respectively.Intraductal ingrowth was seen in 18 (24.7%) patients and histologically confirmed in 12 (16.4%). Intraductal ablation achieved a 100% success rate, with a 20-month median follow-up. Most of these patients had malignant forms (
Conclusions
Intraductal ablation achieves a high therapeutic success rate in ampullary tumors with ≤20 mm ductal extension, even in malignant forms or biliary and pancreatic involvement. The technique is feasible, cheap and safe and may avoid major surgery.
Identifiants
pubmed: 31019705
doi: 10.1177/2050640618817215
pii: 10.1177_2050640618817215
pmc: PMC6466754
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Pagination
369-376Références
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