ENDOSCOPIC RESECTION OF ADVANCED AMPULLARY ADENOMAS: OUTCOMES OF A SINGLE-CENTER RETROSPECTIVE STUDY

Aims:

Ampullary adenomas have a potential of malignant transformation, so complete removal is essential for curative therapy. Endoscopic resection should only be performed in patients without evidence of invasive cancer. This study aims to evaluate the outcome of endoscopic resection of ampullary adenomas in a tertiary endoscopy department.

Methods:

We investigated all patients referred for endoscopic ampullectomy between January 2014 – January 2017 at the Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Romania. All patients had a benign pathological result prior to the endoscopic resection. Post-procedural complications such as bleeding, perforation, cholangitis, pancreatitis and mortality were analyzed. Data about resection type, post resection histology and 1 year follow-up was also processed.

Results:

We included 19 patients with a mean age of 63.5 ± 17.7 years. The mean size of the tumor was 17.4 ± 7.8 mm and all patients had an endoscopic resection. The male to female ratio is 0.7. "En bloc" resection was done in most cases 15/19 (78.9%). Bleeding occurred in 6 cases (31.6%) and two patients (10.5%) developed acute pancreatitis. The average days of hospitalization after endoscopic ampullectomy were 5.7 with a range from 2 to 25 days. Adenocarcinoma was described in the last histopathological result in 4/19 cases (21.1%). One year follow-up noted a recurrence rate of 15.8% (3/19 cases).

Conclusions:

In conclusion, endoscpic resection of ampullary adenomas is a high risk procedure with an increased risk of complications, but performed by experienced endoscopists in selected patients is safe and surgery can be avoided.