Gondran Hannah, Musquer Nicolas, Perez-Cuadrado-Robles Enrique, Deprez Pierre Henri, Buisson François, Berger Arthur, Cesbron-Métivier Elodie, Wallenhorst Timothee, David Nicolas, Cholet Franck, Perrot Bastien, Quénéhervé Lucille, Coron Emmanuel
Institut des Maladies de l'Appareil Digestif (IMAD), CHU Nantes, Nantes, France.
Service de gastroentérologie, Hôpital européen Georges Pompidou, Assistance publique des hôpitaux de Paris, Paris, France.
Therap Adv Gastroenterol. 2022 Apr 22;15:17562848221090820. doi: 10.1177/17562848221090820. eCollection 2022.
Endoscopic papillectomy is a minimally invasive treatment for benign tumors of the ampulla of Vater or early ampullary carcinoma. However, reported recurrence rates are significant and risk factors for recurrence are unclear.
The aims of this study were to evaluate the efficacy and safety of endoscopic papillectomy and to identify risk factors for recurrence and adverse events.
All patients who underwent endoscopic papillectomy at five tertiary referral centers between January 2008 and December 2018 were included. Recurrence was defined as the detection of residue on one of the follow-up endoscopies. Treatment success was defined as the absence of tumor residue on the last follow-up endoscopy.
A total of 227 patients were included. The resections were in 64.8% of cases. The mean lesion size was 20 mm (range: 3-80) with lateral extension in 23.3% of cases. R0 resection was achieved in 45.3% of cases. The recurrence rate was 30.6%, and 60.7% of recurrences were successfully treated with additional endoscopic treatment. Finally, treatment success was achieved in 82.8% of patients with a median follow-up time of 22.3 months. R1 resection, intraductal invasion, and tumor size > 2 cm were associated with local recurrence. Adverse events occurred in 36.6% of patients and included pancreatitis (17.6%), post-procedural hemorrhage (11.0%), perforation (5.2%), and biliary stenosis (2.6%). The mortality rate was 0.9%.
Endoscopic papillectomy is an effective and relatively well-tolerated treatment for localized ampullary tumors. In this series, R1 resection, intraductal invasion, and lesion size > 2 cm were associated with local recurrence.
内镜下乳头切除术是一种用于治疗 Vater 壶腹良性肿瘤或早期壶腹癌的微创治疗方法。然而，报道的复发率较高，且复发的危险因素尚不清楚。
本研究旨在评估内镜下乳头切除术的疗效和安全性，并确定复发及不良事件的危险因素。
纳入 2008 年 1 月至 2018 年 12 月期间在 5 家三级转诊中心接受内镜下乳头切除术的所有患者。复发定义为在随访内镜检查中发现残留病灶。治疗成功定义为最后一次随访内镜检查时无肿瘤残留。
共纳入 227 例患者。64.8%的病例实现了切除。平均病变大小为 20 mm（范围：3 - 80），23.3%的病例有侧向延伸。45.3%的病例实现了 R0 切除。复发率为 30.6%，60.7%的复发病例通过额外的内镜治疗成功治愈。最终，82.8%的患者治疗成功，中位随访时间为 22.3 个月。R1 切除、导管内侵犯和肿瘤大小>2 cm 与局部复发相关。36.6%的患者发生不良事件，包括胰腺炎（17.6%）、术后出血（11.0%）、穿孔（5.2%）和胆管狭窄（2.6%）。死亡率为 0.9%。
内镜下乳头切除术是治疗局限性壶腹肿瘤的一种有效且耐受性相对良好的治疗方法。在本系列研究中，R1 切除、导管内侵犯和病变大小>2 cm 与局部复发相关。
