Gambitta Pietro, Aseni Paolo, Villa Federica, Fontana Paola, Armellino Antonio, Vertemati Maurizio
Gastroenterology Division, Legnano Hospital, ASST Ovest Milanese, Legnano.
Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda.
Surg Laparosc Endosc Percutan Tech. 2021 Feb 3;31(4):462-467. doi: 10.1097/SLE.0000000000000909.
Ampullary tumors, although relatively uncommon, are increasingly diagnosed due to ongoing progress in imaging technology and the diagnostic accuracy of endoscopic ultrasound and magnetic resonance cholangiopancreatography. Endoscopic ampullectomy (EA) has become the preferred treatment option over surgery due to its lower morbidity for benign ampullary adenomas. This study aims to evaluate the efficacy, safety, and outcome of EA in 30 patients with benign-appearing ampullary lesions with particular emphasis on the accuracy of preampullectomy histology and technical details of the pancreatic duct drainage to prevent postprocedural pancreatitis.
Data from a cohort of 30 patients who underwent EA were retrospectively analyzed. Histologic characteristics of the ampullomas, accuracy of histology of pre-EA biopsy specimen, safety of the procedure, recurrence rate, as well as the clinical outcome of all patients, are analyzed and discussed.
Endoscopic resection was successful as a definitive treatment in 25 patients (83.3%). Five patients required additional surgery. In 8 patients, a definitive histologic specimen revealed an adenocarcinoma (3 in situ and 5 invasive). The diagnostic accuracy obtained by preresection biopsy specimen was low (0.70). Pancreatic duct stent placement after snare resection was unsuccessful in 9 patients, and 3 of them developed pancreatitis after EA.
EA appears to be a relatively safe alternative to surgery as the first therapeutic option for selected patients with benign-appearing ampullary adenomas. A correct preoperative evaluation by endoscopic ultrasound and magnetic resonance cholangiopancreatography can help to define the anatomy of the pancreatic duct to improve the success rate of pancreatic stent placement which seems to offer a protective role in the prevention of postprocedural pancreatitis.
壶腹肿瘤虽然相对少见，但由于成像技术以及内镜超声和磁共振胰胆管造影诊断准确性的不断进步，其诊断率日益提高。对于良性壶腹腺瘤，内镜下壶腹切除术（EA）因其较低的发病率已成为优于手术的首选治疗方案。本研究旨在评估EA治疗30例表现为良性的壶腹病变患者的疗效、安全性及结局，特别强调术前活检组织学诊断的准确性以及预防术后胰腺炎的胰管引流技术细节。
对30例行EA患者的队列数据进行回顾性分析。分析并讨论壶腹瘤的组织学特征、EA术前活检标本组织学诊断的准确性、手术安全性、复发率以及所有患者的临床结局。
25例患者（83.3%）内镜切除作为确定性治疗成功。5例患者需要额外手术。8例患者最终组织学标本显示为腺癌（3例原位癌和5例浸润癌）。术前切除活检标本的诊断准确性较低（0.70）。圈套器切除后9例患者胰管支架置入失败，其中3例在EA术后发生胰腺炎。
对于部分表现为良性的壶腹腺瘤患者，EA似乎是一种相对安全的手术替代方案，可作为首选治疗方法。通过内镜超声和磁共振胰胆管造影进行正确的术前评估有助于明确胰管解剖结构，提高胰管支架置入成功率，这似乎对预防术后胰腺炎具有保护作用。
