Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, 1808 7th Avenue, So. BDB 380, Birmingham, AL 35294-0001, USA.
Dig Dis Sci. 2011 Nov;56(11):3235-40. doi: 10.1007/s10620-011-1826-4. Epub 2011 Jul 15.
Ampullary adenomas have the potential to progress from benign to malignant lesions. Endoscopic ampullectomy as curative therapy has gained credibility as a safe and effective alternative to surgical resection. This study was designed to assess outcomes of endoscopic resection of ampullary neoplasms at a single center.
Between May 1996 and August 2009, all patients referred to our center for endoscopic resection of an ampullary lesion were retrospectively identified. Patients were followed for complications and endoscopic surveillance performed per protocol to assess for recurrence.
Endoscopic ampullectomy for adenoma was performed in 38 patients (22 females; mean age, 54.3 years, range, 22-85 years), with high-grade dysplasia (HGD) diagnosed in 6 and low-grade dysplasia (LGD) in 32. A direct relationship was observed between HGD and tumor size (P = 0.03). Lesions less than 2.5 cm in size demonstrated no evidence of invasion. Mean follow-up duration was 17.2 ± 2 months (range, 0-82.5 months). Complications were uniformly mild and occurred in 6 (16%) patients: bleeding in 2, pancreatitis in 3, and infection in 1. Adenoma recurrence was documented in 6 (16%) patients, 4 with LGD and 2 with HGD; no patients had tumors that progressed from LGD to HGD or HGD to cancer. Kaplan-Meier analysis showed insignificant differences in recurrence between HGD and LGD groups (P = 0.13).
Endoscopic ampullectomy is a safe and effective treatment for benign ampullary neoplasms and should become the treatment of choice rather than surgical therapy.
壶腹腺瘤有从良性病变进展为恶性病变的可能。作为一种有前途的治疗方法，内镜下壶腹肿瘤切除术已被证实是一种安全有效的替代手术切除的方法。本研究旨在评估单中心内镜下切除壶腹肿瘤的结果。
回顾性分析 1996 年 5 月至 2009 年 8 月期间，所有因壶腹病变而转诊至本中心行内镜下切除术的患者。根据协议对患者进行随访，以评估并发症和内镜监测是否复发。
38 例患者（22 例女性；平均年龄 54.3 岁，范围 22-85 岁）接受内镜下腺瘤切除术，其中 6 例诊断为高级别异型增生（HGD），32 例诊断为低级别异型增生（LGD）。HGD 与肿瘤大小之间存在直接关系（P=0.03）。病变小于 2.5cm 者无浸润证据。平均随访时间为 17.2±2 个月（范围 0-82.5 个月）。并发症均为轻度，发生于 6 例（16%）患者：2 例出血，3 例胰腺炎，1 例感染。6 例（16%）患者发现腺瘤复发，其中 4 例为 LGD，2 例为 HGD；无患者的肿瘤从 LGD 进展为 HGD 或 HGD 进展为癌症。Kaplan-Meier 分析显示 HGD 和 LGD 组之间的复发无显著差异（P=0.13）。
内镜下壶腹肿瘤切除术是治疗良性壶腹肿瘤的一种安全有效的方法，应成为首选治疗方法，而非手术治疗。
