Endoscopic Papillectomy for Benign Ampullary Neoplasms: How Can Treatment Outcome Be Predicted?

Background/Aims: Endoscopic papillectomy is increasingly performed with curative intent for benign papillary tumors. This study was performed to identify factors that predict the presence of malignancy and affect endoscopic success. Methods: We retrospectively analyzed the medical records of patient...

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Published in:Gut and liver 2013-03, Vol.7 (2), p.239
Main Authors: Dong Won Ahn, Ji Kon Ryu, Jaihwan Kim, Won Jae Yoon, Sang Hyub Lee, Yong Tae Kim, Yong Bum Yoon
Format: Article
Language:Korean
Subjects:
Adenocarcinoma
Benign papillary tumor
Endoscopic sphincterotomy
Endoscopic success
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Summary:Background/Aims: Endoscopic papillectomy is increasingly performed with curative intent for benign papillary tumors. This study was performed to identify factors that predict the presence of malignancy and affect endoscopic success. Methods: We retrospectively analyzed the medical records of patients who received an endoscopic papillectomy for papillary adenoma from 2006 to 2009. Results: A total of 43 patients received endoscopic papillectomy. The pathologic results after papillectomy revealed adenocarcinoma in five patients (12%), and the risk of malignancy was high in cases of large lesions, preprocedural pathology of high-grade dysplasia or high serum alkaline phosphatase. Endoscopic success was observed in 37 patients (86%) at the end of follow-up (mean duration, 10.4±9.6 months). The factor significantly affecting success was a complete resection at the initial papillectomy (p=0.007). Two patients experienced recurrence 10 and 32 months after the complete resection, but both achieved endoscopic success with repeated endoscopic treatment. Six patients with endoscopic failure received surgical resection. Conclusions: Endoscopic papillectomy is a safe and effective method for the curative resection of benign papillary tumors, especially when complete resection is achieved at the initial papillectomy. Follow-up with surveillance should be performed for at least 3 years because of the possible recurrence of tumors during these periods. (Gut Liver 2013;7:239-245)
ISSN:1976-2283