Department of Clinical Medicine and Surgery, Center of Excellence for Technical Innovation in Surgery (CEITC), University of Naples Federico II, School of Medicine, Naples, Italy.
Int J Surg. 2015 Jan;13:180-183. doi: 10.1016/j.ijsu.2014.11.045. Epub 2014 Dec 10.
Indications for endoscopic snare papillectomy (ESP) remain controversial. Main concerns with ESP are related to the incomplete removal of the lesion, high recurrence rates and inadequate oncological resection. Aim of the study is to report short and long term outcomes after endoscopic papillectomy in a single institutional series with strict inclusion criteria and a standardized technique.
Patients with ampullary tumors who underwent endoscopic papillectomy over a 5 year period were reviewed. Inclusion criteria for endoscopic resection were: tumor diameter less than 3 cm, no endoscopic evidence of malignancy, absence of infiltration of biliary and pancreatic duct at pre-operative ERCP and tumor confined to the submucosa at EUS. An en-block resection was attempted in all cases, followed by a pancreatic stent insertion whenever possible.
Twenty-seven patients (10 female, mean age 68 y) have been identified. Ampullectomy was successfully performed in all the cases. En bloc resection was completed in 24 patients (88.8%), while 3 patients had a piecemeal resection. A pancreatic stent was successfully placed in all the patients. Five patients experienced complications, including bleeding (2 cases, 7.4%) and acute pancreatitis (3 cases, 11.1%). There was no procedure-related mortality. Histology revealed a poor prognosis in two patients, which were subsequently treated by duodenopancreatectomy. Over a long-term follow-up (median 18 months), one patient developed local recurrence, which was successfully treated with further endoscopic resection. Overall curative resection rate was 92.6%.
Endoscopic ampullectomy allows resection of benign tumors and in situ carcinoma. Strict indications and a proper standardized technique seem to be key factors in order to achieve excellent short and long-term results.
内镜套扎乳头切除术（ESP）的适应证仍存在争议。ESP 的主要关注点与病变的不完全切除、高复发率和不充分的肿瘤切除有关。本研究的目的是报告在严格纳入标准和标准化技术的基础上，在单中心系列中进行内镜乳头切除术的短期和长期结果。
回顾了在 5 年内接受内镜乳头切除术的壶腹肿瘤患者。内镜切除的纳入标准为：肿瘤直径小于 3cm，术前 ERCP 无恶性内镜证据，胆管和胰管无浸润，EUS 肿瘤局限于黏膜下层。所有病例均尝试整块切除，尽可能插入胰管支架。
共确定了 27 例患者（10 例女性，平均年龄 68 岁）。所有病例均成功进行了壶腹切除术。24 例患者（88.8%）完成整块切除，3 例患者行部分切除。所有患者均成功放置胰管支架。5 例患者发生并发症，包括出血（2 例，7.4%）和急性胰腺炎（3 例，11.1%）。无与操作相关的死亡。组织学显示 2 例患者预后不良，随后行胰十二指肠切除术。长期随访（中位数 18 个月）中，1 例患者局部复发，再次行内镜下切除成功。总体根治性切除率为 92.6%。
内镜壶腹切除术可切除良性肿瘤和原位癌。严格的适应证和适当的标准化技术似乎是获得良好短期和长期结果的关键因素。
