Endoscopic Papillectomy for Ampullary Adenomas: A Single-Center Experience

Abstract

Objective: Endoscopic papillectomy is widely accepted as an effective and safe therapeutic modality for the treatment of non-invasive ampullary adenomas. The aim of this study was to evaluate the clinical outcomes of endoscopic papillectomy performed for ampullary adenomas at a single center. Methods: This retrospective study includes patients who underwent endoscopic papillectomy between September 2017 and June 2022. The patients were evaluated with cross-sectional imaging for distant metastasis and intraductal spread before papillectomy. Complete resection was defined as negative vertical and horizontal margins in the histopathological findings after the procedure. Results: Papillectomy was performed in 6 patients (2 male and 4 female) and the mean age of the patients was 59.3 (41-70). The lesion sizes were between 15 mm and 30 mm in endoscopic evaluation. Complete resection was achieved in 4 (67%) patients who underwent en bloc resection, but not in those who underwent piecemeal resection. Post-procedural pathological evaluation of 2 patients who underwent partial resection revealed adenocarcinoma at the resection margin and both were referred to surgery, but none of the patients who underwent en bloc resection had adenocarcinoma. No recurrence was observed in the follow-up of the patients who underwent complete resection. Bleeding that did not require blood transfusion and endoscopic intervention developed in only one patient. Conclusion: Endoscopic papillectomy is a safe and successful treatment modality for both treatment and definitive diagnosis and staging in patients with adenoma confined to the ampulla. Patients undergoing complete resection should be followed up for possible recurrence.