Hôpital Privé Jean Mermoz, Lyon, France.
Service d'hépatogastroentérologie, Hôpital Edouard Herriot, Lyon, France.
Endoscopy. 2014 Feb;46(2):127-34. doi: 10.1055/s-0034-1364875. Epub 2014 Jan 29.
Endoscopic papillectomy of early tumors of the ampulla of Vater is an alternative to surgery. This large prospective multicenter study was aimed at evaluating the long-term results of endoscopic papillectomy.
Between September 2003 and January 2006, 10 centers included all patients referred for endoscopic papillectomy and meeting the inclusion criteria: biopsies showing at least adenoma, a uT1N0 lesion without intraductal involvement at endoscopic ultrasound (EUS), and no previous treatment. A standardized endoscopic papillectomy was done, with endoscopic monitoring with biopsies 4 - 8 weeks later where complications were recorded and complementary resection performed when necessary. Follow-up with duodenoscopy, biopsies, and EUS was done at 6, 12, 18, 24 and 36 months. Therapeutic success was defined as complete resection (no residual tumor found at early monitoring) without duodenal submucosal invasion in the resection specimen in the case of adenocarcinoma and without relapse during follow-up.
93 patients were enrolled. Mortality was 0.9 % and morbidity 35 %, including pancreatitis in 20 %, bleeding 10 %, biliary complications 7 %, perforation 3.6 %, and papillary stenosis in 1.8 %. Adenoma was not confirmed in the resection specimen in 14 patients who were therefore excluded. Initial treatment was insufficient in 9 cases (8 carcinoma with submucosal invasion; 1 persistence of adenoma). During follow-up, 5 patients had tumor recurrence and 7 died from unrelated diseases without recurrence. Finally, 81.0 % of patients were cured (95 % confidence interval 72.3 % - 89.7 %).
Endoscopic papillectomy of selected ampullary tumors is curative in 81.0 % of cases. It must be considered to be the first-line treatment for early tumors of the ampulla of Vater without intraductal invasion.
内镜下乳头肿瘤切除术是治疗 Vater 壶腹早期肿瘤的一种替代方法。本项大型前瞻性多中心研究旨在评估内镜下乳头肿瘤切除术的长期疗效。
2003 年 9 月至 2006 年 1 月，10 个中心纳入所有符合纳入标准的患者：内镜超声（EUS）显示至少为腺瘤，uT1N0 病变且无管内受累，且无先前治疗史。进行标准的内镜乳头肿瘤切除术，并在内镜监测下进行 4-8 周后的活检，记录并发症，并在必要时进行补充切除。术后 6、12、18、24 和 36 个月进行十二指肠镜检查、活检和 EUS 随访。治疗成功定义为在早期监测中无残留肿瘤（在切除标本中未发现残留肿瘤）且腺癌无十二指肠黏膜下侵犯，或在随访中无复发。
共纳入 93 例患者。死亡率为 0.9%，发病率为 35%，包括胰腺炎 20%、出血 10%、胆管并发症 7%、穿孔 3.6%和乳头狭窄 1.8%。14 例患者切除标本中未证实腺瘤，因此被排除在外。9 例初始治疗不足（8 例为黏膜下浸润癌；1 例为腺瘤持续存在）。随访期间，5 例患者肿瘤复发，7 例患者死于无复发的相关疾病。最终，81.0%的患者治愈（95%置信区间 72.3%-89.7%）。
对于选择的壶腹肿瘤，内镜下乳头肿瘤切除术的治愈率为 81.0%。对于无管内受累的 Vater 壶腹早期肿瘤，应考虑将其作为一线治疗方法。
