Alali Ali, Espino Alberto, Moris Maria, Martel Myriam, Schwartz Ingrid, Cirocco Maria, Streutker Catherine, Mosko Jeffrey, Kortan Paul, Barkun Alan, May Gary R
The Center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Haya Al-Habeeb Gastroenterology and Hepatology Center, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait.
J Can Assoc Gastroenterol. 2020 Feb;3(1):17-25. doi: 10.1093/jcag/gwz007. Epub 2019 Mar 18.
The management of ampullary lesions has shifted from surgical approach to endoscopic resection. Previous reports were limited by small numbers of patients and short follow-up. The aim of this study is to describe short- and long-term outcomes in a large cohort of patients undergoing endoscopic ampullectomy.
Retrospective study of endoscopic ampullectomies performed at a tertiary center from January 1999 to October 2016. Information recorded includes patient demographics, clinical outcomes, lesion pathology, procedural events, adverse events and follow-up data.
Overall, 103 patients underwent endoscopic resection of ampullary tumours (mean age 62.3 ± 14.3 years, 50.5% female, mean lesion size 20.9 mm; 94.9% adenomas, with a majority of lesions exhibiting low-grade dysplasia (72.7%). Complete endoscopic resection was achieved in 82.5% at initial procedure. Final complete endoscopic resection was achieved in all patients with benign pathology on follow-up procedures. Final pathology showed that 11% had previously undiagnosed invasive carcinoma. Delayed postprocedure bleeding occurred in 21.4%, all of which were managed successfully at endoscopy. Acute pancreatitis complicated 15.5% of procedures (mild in 93.8%). Perforation occurred in 5.8%, all treated conservatively except for one patient requiring surgery. Piecemeal resection was associated with significantly higher recurrence compared to en-bloc resection (54.3% versus 26.2%, respectively, = 0.012). All recurrences were treated endoscopically.
Endoscopic ampullectomy appears both safe and effective in managing patients with ampullary tumours in experienced hands. Most adverse events can be managed conservatively. Many patients develop recurrence during long-term follow-up but can be managed endoscopically. Recurrence rates may be reduced by performing initial en-bloc resection.
壶腹病变的治疗已从手术方法转向内镜切除术。以往的报告受限于患者数量少和随访时间短。本研究的目的是描述接受内镜下壶腹切除术的一大群患者的短期和长期结果。
对1999年1月至2016年10月在一家三级中心进行的内镜下壶腹切除术进行回顾性研究。记录的信息包括患者人口统计学、临床结果、病变病理、手术事件、不良事件和随访数据。
总体而言，103例患者接受了壶腹肿瘤的内镜切除术（平均年龄62.3±14.3岁，女性占50.5%，平均病变大小20.9mm；94.9%为腺瘤，大多数病变表现为低级别异型增生（72.7%）。初次手术时82.5%实现了内镜下完全切除。随访手术中所有良性病理的患者最终均实现了内镜下完全切除。最终病理显示11%有先前未诊断出的浸润性癌。术后延迟出血发生率为21.4%，所有出血均在内镜检查时成功处理。急性胰腺炎在15.5%的手术中出现并发症（93.8%为轻度）。穿孔发生率为5.8%，除1例患者需要手术外，其余均保守治疗。与整块切除相比，分块切除的复发率显著更高（分别为54.3%和26.2%，P = 0.012）。所有复发均通过内镜治疗。
在内镜技术熟练的医生手中,内镜下壶腹切除术在治疗壶腹肿瘤患者方面似乎既安全又有效。大多数不良事件可以保守处理。许多患者在长期随访中出现复发，但可通过内镜治疗。通过进行初次整块切除可能降低复发率。
