Endoscopic papillectomy for early ampullary tumors: long-term results from a large multicenter prospective study

Bertrand Napoleon; Rodica Gincul; Thierry Ponchon; Julien Berthiller; Jean Escourrou; Jean-Marc Canard; Jean Boyer; Marc Barthet; Philippe Ponsot; René Laugier; Thierry Helbert; Dimitri Coumaros; Jean-Yves Scoazec; François Mion; Jean-Christophe Saurin; the Sociéte Française d’Endoscopie Digestive (SFED, French Society of Digestive Endoscopy)

doi:10.1055/s-0034-1364875

Endoscopy, Table of Contents

Endoscopy 2014; 46(02): 127-134
DOI: 10.1055/s-0034-1364875

Original article

Endoscopic papillectomy for early ampullary tumors: long-term results from a large multicenter prospective study

Bertrand Napoleon

¹Hôpital Privé Jean Mermoz, Lyon, France

,

Rodica Gincul

²Service d’hépatogastroentérologie, Hôpital Edouard Herriot, Lyon, France

,

Thierry Ponchon

²Service d’hépatogastroentérologie, Hôpital Edouard Herriot, Lyon, France

,

Julien Berthiller

³Unité d’épidémiologie clinique, Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, France

,

Jean Escourrou

⁴Service de gastroentérologie CHU Rangueil 1, Toulouse, France

,

Jean-Marc Canard

⁵Clinique du Trocadéro, Paris, France

,

Jean Boyer

⁶Service de gastroentérologie CHU Angers 4, Angers, France

,

Marc Barthet

⁷Service de gastroentérologie Hôpital Nord, Marseille, France

,

Philippe Ponsot

⁸Service de gastroentérologie Hôpital Beaujon, Clichy, France

,

René Laugier

⁹Service de gastroentérologie Hôpital de la Timone, Marseille, France

,

Thierry Helbert

¹⁰Service de gastroentérologie Hôpital Ambroise Paré, Marseille, France

,

Dimitri Coumaros

¹¹Hôpital Civil de Strasbourg, Strasbourg, France

,

Jean-Yves Scoazec

¹²Service d’anatomopathologie, Hôpital Edouard Herriot, Lyon, France

,

François Mion

²Service d’hépatogastroentérologie, Hôpital Edouard Herriot, Lyon, France

,

Jean-Christophe Saurin

²Service d’hépatogastroentérologie, Hôpital Edouard Herriot, Lyon, France

,

the Sociéte Française d’Endoscopie Digestive (SFED, French Society of Digestive Endoscopy)

› Author Affiliations

Abstract

Background and study aims: Endoscopic papillectomy of early tumors of the ampulla of Vater is an alternative to surgery. This large prospective multicenter study was aimed at evaluating the long-term results of endoscopic papillectomy.

Patients and methods: Between September 2003 and January 2006, 10 centers included all patients referred for endoscopic papillectomy and meeting the inclusion criteria: biopsies showing at least adenoma, a uT1N0 lesion without intraductal involvement at endoscopic ultrasound (EUS), and no previous treatment. A standardized endoscopic papillectomy was done, with endoscopic monitoring with biopsies 4 – 8 weeks later where complications were recorded and complementary resection performed when necessary. Follow-up with duodenoscopy, biopsies, and EUS was done at 6, 12, 18, 24 and 36 months. Therapeutic success was defined as complete resection (no residual tumor found at early monitoring) without duodenal submucosal invasion in the resection specimen in the case of adenocarcinoma and without relapse during follow-up.

Results: 93 patients were enrolled. Mortality was 0.9 % and morbidity 35 %, including pancreatitis in 20 %, bleeding 10 %, biliary complications 7 %, perforation 3.6 %, and papillary stenosis in 1.8 %. Adenoma was not confirmed in the resection specimen in 14 patients who were therefore excluded. Initial treatment was insufficient in 9 cases (8 carcinoma with submucosal invasion; 1 persistence of adenoma). During follow-up, 5 patients had tumor recurrence and 7 died from unrelated diseases without recurrence. Finally, 81.0 % of patients were cured (95 % confidence interval 72.3 % – 89.7 %).

Conclusion: Endoscopic papillectomy of selected ampullary tumors is curative in 81.0 % of cases. It must be considered to be the first-line treatment for early tumors of the ampulla of Vater without intraductal invasion.

Full Text

References

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