Clinical outcomes: endoscopic resection of duodenal ampullary lesions.

IF 3 4区医学 Q1 Medicine Translational gastroenterology and hepatology Pub Date : 2023-01-01 DOI:10.21037/tgh-22-87

Stephanie M Woo, Mark J Real, Brett M Will, Eric J Kim, Jiling Chou, Ahmed A Alsaiari, Ahmad Nakshabandi, Walid M Chalhoub, Nadim G Haddad

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Abstract

Background: Ampullary adenomas are lesions at the duodenum's major papilla commonly associated with familial adenomatous polyposis (FAP) but may also occur sporadically. Historically, ampullary adenomas were removed surgically, however endoscopic resection has become the preferred method of resection. Most of the literature on management of ampullary adenomas are small single-center retrospective reviews. The objective of this study is to describe endoscopic papillectomy outcomes to further refine management guidelines.

Methods: This is a retrospective study of patients who underwent endoscopic papillectomy. Demographic data were included. Details regarding lesions and procedures were also collected, including endoscopic impression, size, resection method and adjunctive therapies. Chi-square, Kruskal-Wallis rank-sum, and t-tests were performed.

Results: A total of 90 patients were included. 60% patients (54 of 90) had pathology-proven adenomas. 14.4% of all lesions (13 of 90) and 18.5% of adenomas (10 of 54) were treated with APC. Among APC-treated lesions, 36.4% developed recurrence (4 of 11) vs. 7.1% developed residual lesion (1 of 14) (P=0.019). 15.6% of all lesions (14 of 90) and 18.5% of adenomas (10 of 54) reported complications, and the most common was pancreatitis (11.1% and 5.6%). Median follow-up time was 8 months for all lesions and 14 months (range, 1-177 months) for adenomas, with time to recurrence 30 and 31 months (range, 1-137 months), respectively. Recurrence was observed in 16.7% of all lesions (15 of 90) and 20.4% of adenomas (11 of 54). Endoscopic success was observed in 69.2% of all lesions (54 of 78) and 71.4% of adenomas (35 of 49) after removing patients lost to follow-up.

Conclusions: Endoscopic papillectomy is an effective method for managing duodenal adenomas. Pathology-proven adenoma should undergo surveillance for at least 31 months. Lesions treated with APC may require closer follow-up and for a prolonged period.

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临床结果:内镜下十二指肠壶腹部病变切除术。

背景:壶腹腺瘤是十二指肠主要乳头的病变，通常与家族性腺瘤性息肉病(FAP)有关，但也可能零星发生。从历史上看，壶腹腺瘤是通过手术切除的，但内镜切除已成为首选的切除方法。大多数关于壶腹腺瘤治疗的文献都是小的单中心回顾性综述。本研究的目的是描述内窥镜乳头切除术的结果，以进一步完善治疗指南。方法:这是一项对内镜下乳头切除术患者的回顾性研究。包括人口统计数据。还收集了有关病变和手术的详细信息，包括内镜印象、大小、切除方法和辅助治疗。进行卡方检验、Kruskal-Wallis秩和检验和t检验。结果:共纳入90例患者。60例患者(90例中的54例)有病理证实的腺瘤。14.4%的病变(90例中的13例)和18.5%的腺瘤(54例中的10例)接受了APC治疗。在apc治疗的病变中，36.4%复发(11例中有4例)，7.1%出现残留病变(14例中有1例)(P=0.019)。15.6%的病变(14 / 90)和18.5%的腺瘤(10 / 54)报告了并发症，最常见的是胰腺炎(11.1%和5.6%)。所有病变的中位随访时间为8个月，腺瘤的中位随访时间为14个月(范围1-177个月)，复发时间分别为30个月和31个月(范围1-137个月)。复发率为16.7%(15 / 90)，腺瘤为20.4%(11 / 54)。内镜下切除后，69.2%的病变(78例中的54例)和71.4%的腺瘤(49例中的35例)患者随访失败。结论:内镜下乳头切除术是治疗十二指肠腺瘤的有效方法。病理证实的腺瘤应接受至少31个月的监测。用APC治疗的病变可能需要更密切的随访和更长的时间。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Translational gastroenterology and hepatology Medicine-Gastroenterology

CiteScore

8.20

自引率

0.00%

发文量

期刊介绍： Translational Gastroenterology and Hepatology (Transl Gastroenterol Hepatol; TGH; Online ISSN 2415-1289) is an open-access, peer-reviewed online journal that focuses on cutting-edge findings in the field of translational research in gastroenterology and hepatology and provides current and practical information on diagnosis, prevention and clinical investigations of gastrointestinal, pancreas, gallbladder and hepatic diseases. Specific areas of interest include, but not limited to, multimodality therapy, biomarkers, imaging, biology, pathology, and technical advances related to gastrointestinal and hepatic diseases. Contributions pertinent to gastroenterology and hepatology are also included from related fields such as nutrition, surgery, public health, human genetics, basic sciences, education, sociology, and nursing.