Kang Sung Hoon, Kim Kook Hyun, Kim Tae Nyeun, Jung Min Kyu, Cho Chang Min, Cho Kwang Bum, Han Ji Min, Kim Ho Gak, Kim Hyun Soo
Division of Gastroenterology and hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, 317-1 Daemyung-dong, 705-717, Nam-gu, Daegu, South Korea.
Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, South Korea.
BMC Gastroenterol. 2017 May 30;17(1):69. doi: 10.1186/s12876-017-0626-5.
Endoscopic papillectomy (EP) is reported to be a relatively safe and reliable procedure for complete resection of ampullary neoplasms. The aim of this study was to evaluate the therapeutic outcomes and complications of EP for ampullary neoplasms.
A retrospective multicenter study was conducted with 5 participating centers from January 2007 to July 2014. A total of 104 patients who underwent EP for ampullary neoplasms were reviewed retrospectively. EP was performed by snare resection with or without submucosal lifting of the lesion.
The mean age of patients was 60.5 ± 12.1 years, and the male-to-female ratio was 2.0:1. En bloc resection was possible in 94 patients (90.3%). A biliary and a pancreatic stent were placed after EP in 42 patients and in 60 patients, respectively. A pathologically incomplete resection was noted in 11 cases (10.6%), and 5 of these patients were treated with additional endoscopic procedure. Histology of resected specimens was as follows: low grade adenoma (43.2%), high grade adenoma (14.4%), adenocarcinoma (16.3%), hyperplastic polyp (7.7%), and others (18.4%). Of the 75 cases with low grade adenoma on biopsy specimen, 21.3% turned out to have high grade adenoma (12%) or adenocarcinoma (9.3%). Procedure-related complications occurred in 33 patients (31.7%); bleeding (18 cases, 17.3%), pancreatitis (16 cases, 15.4%), and perforation (8 cases, 7.7%). Pre-EP ERCP, saline lifting, sphincterotomy, biliary stenting, pancreatic stenting, specimen size, and cauterization were not related to post EP complications. Surgery was performed in 6 cases with pathological incomplete resection and 2 cases with complications after EP, and there were 2 cases of mortality due to complications. During follow-up endoscopy after initial success of EP, remnant tumors were found in 7 patients, one of whom underwent surgery and the others were treated endoscopically. Consequently, the overall endoscopic success rate of EP was 89.4%.
Endoscopic papillectomy appears to be an effective treatment for ampullary neoplasms, and can be considered as an alternative to surgery. However, relatively high risk of procedure related complications is a problem that must be considered.
据报道，内镜下乳头切除术（EP）是一种相对安全可靠的完全切除壶腹肿瘤的手术方法。本研究旨在评估EP治疗壶腹肿瘤的疗效及并发症。
2007年1月至2014年7月，对5个参与中心进行了一项回顾性多中心研究。回顾性分析了104例行EP治疗壶腹肿瘤的患者。EP通过圈套切除术进行，病变可进行或不进行黏膜下抬举。
患者平均年龄为60.5±12.1岁，男女比例为2.0:1。94例患者（90.3%）实现整块切除。分别有42例和60例患者在EP术后放置了胆管支架和胰管支架。11例（10.6%）病理切除不完全，其中5例患者接受了额外的内镜手术。切除标本的组织学类型如下：低级别腺瘤（43.2%）、高级别腺瘤（14.4%）、腺癌（16.3%）、增生性息肉（7.7%）和其他（18.4%）。活检标本为低级别腺瘤的75例患者中，21.3%最终诊断为高级别腺瘤（12%）或腺癌（9.3%）。33例患者（31.7%）发生了与手术相关的并发症；出血（18例，17.3%）、胰腺炎（16例，15.4%）和穿孔（8例，7.7%）。EP术前的内镜逆行胰胆管造影（ERCP）、生理盐水抬举、括约肌切开术、胆管支架置入、胰管支架置入、标本大小和烧灼与EP术后并发症无关。6例病理切除不完全和2例EP术后出现并发症的患者接受了手术治疗，有2例患者因并发症死亡。在EP首次成功后的随访内镜检查中，7例患者发现残留肿瘤，其中1例接受了手术治疗，其余患者接受了内镜治疗。因此，EP的总体内镜成功率为89.4%。
内镜下乳头切除术似乎是治疗壶腹肿瘤的有效方法，可被视为手术的替代方法。然而，与手术相关的并发症风险相对较高是一个必须考虑的问题。
