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Management after endoscopic snare papillectomy for ampullary adenomas.

Authors
Kim, JH; Hwang, JC; Yoo, BM; Moon, JH; Lee, DK; Kim, HG; Cho, YD; Lee, DH; Park, SH
Citation
Hepato-gastroenterology, 60(126):1268-1273, 2013
Journal Title
Hepato-gastroenterology
ISSN
0172-6390
Abstract
BACKGROUND/AIMS: This study was designed to investigate clinicopathological features of patients who underwent endoscopic snare papillectomy (ESP) and to suggest how to manage patients after the procedure according to the pathological findings.



METHODOLOGY: Seventy-nine patients underwent ESP for ampullary tumors in 7 tertiary medical centers in Korea. We retrospectively reviewed the medical records of each patient and analyzed the data.



RESULTS: Complete resection and complication rates of ESP were 76% and 21.7%, respectively; and pancreatitis rate was 11.5%. ESP-related mortality rate was 2.5% (n=2; 1 perforation and 1 pancreatitis). According to the pathological findings, endoscopic management was performed in 62/65 (95.4%) of low grade dysplasia (LGD) and 9/14 (64.3%) of high grade dysplasia (HGD)/cancer on pre-ESP; in 57/62 (92.0%) of LGD and 13/16 (81.3%) of HGD/cancer on ESP; and in 11/13(84.7%) of LGD and 0/6(0%) of HGD/cancer on follow-up biopsy. The rates of incomplete resection according to the pre-ESP pathological findings were 18.4% (12/65) in the LGD group and 50% (7/14) in the HGD/cancer group (p=0.033).



CONCLUSIONS: HGD or cancer required surgical management. Moreover, pre-procedural HGD/cancer was associated with a high rate of incomplete resection after ESP. Therefore, if the pre-ESP pathological results revealed HGD/cancer, a careful endoscopic follow-up with imaging study or an early surgical intervention should be considered.
MeSH terms
Adenoma/pathology/*surgeryAdultAgedAged, 80 and overAmpulla of Vater/*surgeryCommon Bile Duct Neoplasms/pathology/*surgeryEndoscopyFemaleHumansMaleMiddle AgedRetrospective Studies
DOI
10.5754/hge11604
PMID
23492013
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Surgery
Journal Papers > School of Medicine / Graduate School of Medicine > Gastroenterology
AJOU Authors
김, 지훈김, 진홍황, 재철유, 병무
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