Year 2016 / Volume 108 / Number 5
Review
Endoscopic ampullectomy: a technical review

271-278

DOI: 10.17235/reed.2016.3867/2015

Jesús Espinel, Eugenia Pinedo, Vanesa Ojeda, María Guerra del Río,

Abstract
Background and aim: This article provides a practical review to undertaking safe endoscopic ampullectomy and highlights some of the common difficulties with this technique as well as offering strategies to deal with these challenges. Methods: We conducted a review of studies regarding endoscopic ampullectomy for ampullary neoplasms with special focus on techniques. Results: Accurate preoperative diagnosis and staging of ampullary tumors is imperative for predicting prognosis and determining the most appropriate therapeutic approach. The optimal technique for endoscopic ampullectomy is dependent on the lesions size. En bloc resection is recommended for lesions confined to the papilla. There is no significant evidence to support the submucosal injection before ampullectomy. There is no consensus regarding the optimal current and power output for endoscopic ampulectomy. The benefits of a thermal adjunctive therapy remain controversial. A prophylactic pancreatic stent reduces the incidence and severity of pancreatitis post-ampullectomy. Conclusions: Endoscopic ampullectomy is a safe and efficacious therapeutic procedure for papillary adenomas in experienced endoscopist and it can avoid the need for surgical intervention.
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References
1. Grobmyer SR, Stasik CN, Draganov P et al. Contemporary results with ampullectomy for 29 ‘‘benign’’ neoplasms of the ampulla. J Am Coll Surg. 2008; 206:466–71.
2. Sato T, Konishi K, Kimura H et al. Adenoma and tiny carcinoma in adenoma of the papilla of Vater-p53 and PCNA. Hepatogastroenterology 1999; 46: 1959-62.
3. Baker HL, Caldwell DW. Lesions of the ampulla of Vater. Surgery 1947; 21: 523-31.
4. Binmoeller KF, Boaventura S, Ramsperger K, et al. Endoscopic snare excision of benign adenomas of the papilla of Vater. Gastrointest Endosc 1993; 39:127-31.
5. Beger HG, Staib L, Schoenberg MH. Ampullectomy for adenoma of the papilla and ampulla of Vater. Langenbecks Arch Surg 1998; 383: 190-3.
6. Cheng CL, Sherman S, Fogel EL et al. Endoscopic snare papillectomy for tumors of the duodenal papillae. Gastrointest Endosc 2004; 60:757-64.
7. Matsumoto T, Iida M, Nakamura S et al. Natural history of ampullary adenoma in familial adenomatous polyposis: reconfirmation of benign nature during extended surveillance. Am J Gastroenterol. 2000; 95:1557–62.
8. Demetriades H, Zacharakis E, Kirou I et al. Local excision as a treatment for tumors of ampulla of Vater. World J Surg Oncol 2006; 4:14
9. Catalano MF, Linder JD, Chak A et al. Endoscopic management of adenoma of the major duodenal papilla. Gastrointest Endosc 2004; 59:225–32.
10. Jung MK, Cho CM, Park SY, et al. Endoscopic resection of ampullary neoplasms: a single-center experience. Surg Endosc 2009; 23:2568–74.
11. Ponchon T, Berger F, Chavaillon A, et al. Contribution of endoscopy to diagnosis and treatment of tumors of the ampulla of Vater. Cancer 1989; 64:161–7.
12. Zadorova Z, Dvorak M, Hajer J. Endoscopic therapy of benign tumors of the papilla of Vater. Endoscopy 2001; 33:345–7.
13. Desilets DJ, Dy RM, Ku PM et al. Endoscopic management of tumors of the major duodenal papilla: refined techniques to improve outcome and avoid complications. Gastrointest Endosc 2001; 54:202–8.
14. Norton ID, Gostout CJ, Baron TH et al. Safety and outcome of endoscopic snare excision of the major duodenal papilla. Gastrointest Endosc 2002; 56:239–43.
15. Bohnacker S, Seitz U, Nguyen D et al. Endoscopic resection of benign tumors of the duodenal papilla without and with intraductal growth. Gastrointest Endosc 2005; 62:551–60.
16. Katsinelos P, Paroutoglou G, Kountouras J et al. Safety and long-term follow-up of endoscopic snare excision of ampullary adenomas. Surg Endosc 2006; 20:608–13.
17. Boix J, Lorenzo-Zuniga V, Moreno de Vega V et al. Endoscopic resection of ampullary tumors: 12-year review of 21 cases. Surg Endosc 2009; 23:45–9.
18. Jeanniard-Malet O, Caillol F, Pesenti C et al. Short-term results of 42 endoscopic ampullectomies: a single-center experience. Scand J Gastroenterol 2011; 46:1014–9.
19. Ceppa EP, Burbridge RA, Rialon KL et al. Endoscopic versus surgical ampullectomy: an algorithm to treat disease of the ampulla of vater. Ann Surg 2013; 257: 315-22.
20. Ito K, Fujita N, Noda Y. Endoscopic diagnosis and treatment of ampullary neoplasm (with video). Dig Endosc. 2011; 23:113-7.
21. Martin JA, Haber GB, Kortan PP et al. Endoscopic snare ampullectomy for resection of benign ampullary neoplasms. Gastrointestinal Endoscopy 1997;45: AB25-188.
22. Sauvanet A, Chapuis O, Hammel P et al. Are endoscopic procedures able to predict the benignity of ampullary tumors? Am J Surg 1997; 174:355-8.
23. Cahen DL, Fockens P, de Wit LT et al. Local resection or pancreaticoduodenectomy for villous adenoma of the ampulla of Vater diagnosed before operation. Br J Surg 1997; 84: 948–51.
24. Yamaguchi K, Enjoji M, Kitamura K. Endoscopic biopsy has limited accuracy in diagnosis of ampullary tumors. Gastrointest Endosc 1990; 36:588–92.
25. Yamaguchi K, Enjoji M. Adenoma of the ampulla of Vater: putative precancerous lesion. Gut.1991;32:1558-61.
26. Yamaguchi K, Enjoji M. Carcinoma of the ampulla of vater. A clinicopathologic study and pathologic staging of 109 cases of carcinoma and 5 cases of adenoma. Cancer. 1987;59:506-15.
27. Posner S, Colletti L, Knol J et al. Safety and long-term efficacy of transduodenal excision for tumors of the ampulla of Vater. Surgery. 2000;128:694-701.
28. Clary BM, Tyler DS, Dematos P et al. Local ampullary resection with careful intraoperative frozen section evaluation for presumed benign ampullary neoplasms. Surgery. 2000;127:628-33.
29. Lee SY, Jang KT, Lee KT et al. Can endoscopic resection be applied for early stage ampulla of Vater cancer? Gastrointest Endosc. 2006;63:783-8.
30. Bourgeois N, Dunham F, Verhest A et al. Endoscopic biopsies of the papilla of Vater at the time of endoscopic sphincterotomy: difficulties in interpretation. Gastrointest Endosc. 1984;30:163-6.
31. Shemesh E, Nass S, Czerniak A. Endoscopic sphincterotomy and endoscopic fulguration in the management of adenoma of the papilla of Vater. Surg Gynecol Obstet. 1989;169:445-8.
32. Rattner DW, Fernandez-del-Castillo C, Brugge WR et al. Defining the criteria for local resection of ampullary neoplasms. Arch Surg 1996; 131:366-71.
33. Tio TL, Sie LH, Verbeek PC et al. Endosonography in diagnosing and staging duodenal villous adenoma. Gut 1992; 33: 567-8.
34. Azih LC, Broussard BL, Phadnis MA, et al. Endoscopic ultrasound evaluation in the surgical treatment of duodenal and peri-ampullary adenomas. World J Gastroenterol. 2013;19:511-5.
35. Lim GJ, Devereaux BM. EUS in the assessment of ampullary lesions prior to endoscopic resection. Tech Gastroint Endosc 2010; 12:49–52.
36. Itoh A, Goto H, Naitoh Y et al. Intraductal ultrasonography in diagnosing tumor extension of cancer of the papilla of Vater. Gastrointest Endosc 1997; 45:251-60.
37. Cannon ME, Carpenter SL, Elta GH et al. EUS compared with CT, magnetic resonance imaging, and angiography and the influence of biliary stenting on staging accuracy of ampullary neoplasms. Gastrointest Endosc 1999; 50:27-33.
38. Chen CH, Yang CC, Yeh YH et al. Reappraisal of endosonography of ampullary tumors: correlation with transabdominal sonography, CT, and MRI. J Clin Ultrasound 2009; 37:18-25.
39. Manta R, Conigliaro R, Castellani D et al. Linear endoscopic ultrasonography vs magnetic resonance imaging in ampullary tumors. World J Gastroenterol 2010; 16:5592-7.
40. Baille J. Endoscopic ampullectomy. Am J Gastroenterol 2005; 100:2379-81.
41. Suzuki K, Kantou U, Murakami Y. Two cases with ampullary cancer who underwent endoscopic excision. Prog Dig Endosc 1983; 23:236-9.
42. Ito K, Fujita N, Noda Y et al. Preoperative evaluation of ampullary neoplasm with EUS and transpapillary intraductal US: a prospective and histopathologically controlled study. Gastrointest Endosc 2007; 66:740-7.
43. Okano N, Igarashi Y, Miura T. The study of early complications of endoscopic papillectomy of the tumor with duodenal major papilla. Tando (Journal of Japan Biliary Association) 2007; 21: 623–9. (in Japanese with English abstract).
44. Irani S, Arai A, Ayub K et al. Papillectomy for ampullary neoplasm: results of a single referral center over a 10-year period. Gastrointest. Endosc. 2009; 70: 923–32.
45. Trikudanathan G, Njei B, Attam R et al. Staging accuracy of ampullary tumors by endoscopic ultrasound: Meta-analysis and systematic review. Dig Endosc. 2014;26:617-26.
46. Hopper AD, Bourke MJ, Williams SJ et al. Giant laterally spreading tumors of the papilla: endoscopic features, resection technique, and outcome (with videos). Gastrointest Endosc. 2010;71:967-75.
47. Standards of Practice Committee, Adler DG, Qureshi W, Davila R, et al. The role of endoscopy in ampullary and duodenal adenomas. Gastrointest Endosc 2006; 64:849-54.
48. Martin JA, Haber GB. Ampullary adenoma: clinical manifestations, diagnosis, and treatment. Gastrointest Endosc Clin N Am. 2003;13:649-69.
49. Chini P, Draganov PV. Diagnosis and management of ampullary adenoma: The expanding role of endoscopy. World J Gastrointest Endosc. 2011;3:241-7.
50. Bassan M, Bourke M. Endoscopic ampullectomy: a practical guide. J Interv Gastroenterol. 2012;2:23-30.
51. Aiura K, Imaeda H, Kitajima M et al. Balloon-catheter-assisted endoscopic snare papillectomy for benign tumors of the major duodenal papilla. Gastrointest Endosc. 2003;57:743-7.
52. Ito K, Fujita N, Noda Y et al. Impact of technical modification of endoscopic papillectomy for ampullary neoplasm on the occurrence of complications. Dig Endosc. 2012;24:30-5.
53. Menees SB, Schoenfeld P, Kim HM et al. A survey of ampullectomy practices. World J Gastroenterol 2009; 15: 3486-92.
54. El Hajj II, Coté GA. Endoscopic diagnosis and management of ampullary lesions. Gastrointest Endosc Clin N Am. 2013;23:95-109.
55. Espinel J, Pinedo E, Vaquero LM, et al. Ampulectomia endoscópica en el diagnóstico y tratamiento de tumores ampulares. Endoscopy 2013; 45-A84.
56. Lambert R, Ponchon T, Chavaillon A et al. Laser treatment of tumors of the papilla of Vater. Endoscopy. 1988;20 (Suppl 1):227 -31.
57. Bertoni G, Sassatelli R, Nigrisoli E et al. Endoscopic snare papillectomy in patients with familial adenomatous polyposis and ampullary adenoma. Endoscopy. 1997;29:685-8.
58. Norton ID, Geller A, Petersen BT et al. Endoscopic surveillance and ablative therapy for periampullary adenomas. Am J Gastroenterol. 2001;96:101-6.
59. Yamao T, Isomoto H, Kohno S et al. Endoscopic snare papillectomy with biliary and pancreatic stent placement for tumors of the major duodenal papilla. Surg Endosc. 2010;24:119-24.
60. Lee SK, Kim MH, Seo DW et al. Endoscopic sphincterotomy and pancreatic duct stent placement before endoscopic papillectomy: are they necessary and safe procedures? Gastrointest Endosc. 2002;55:302-4.
61. Harewood GC, Pochron NL, Gostout CJ. Prospective, randomized, controlled trial of prophylactic pancreatic stent placement for endoscopic snare excision of the duodenal ampulla. Gastrointest Endosc. 2005;62:367-70.
62. Singh P, Das A, Isenberg G et al. Does prophylactic pancreatic stent placement reduce the risk of post-ERCP acute pancreatitis? A meta-analysis of controlled trials. Gastrointest Endosc. 2004;60:544-50.
63. Vogt M, Jakobs R, Benz C et al. Endoscopic therapy of adenomas of the papilla of Vater. A retrospective analysis with long-term follow-up. Dig Liver Dis. 2000;32:339-45.
64. Patel R, Davitte J, Varadarajulu S et al. Endoscopic resection of ampullary adenomas: complications and outcomes. Dig Dis Sci. 2011;56:3235-40.
65. Nguyen N, Shah JN, Binmoeller KF. Outcomes of endoscopic papillectomy in elderly patients with ampullary adenoma or early carcinoma. Endoscopy. 2010;42:975-7.
66. Dumonceau JM, Andriulli A, Elmunzer BJ et al; European Society of Gastrointestinal Endoscopy. Prophylaxis of post-ERCP pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - updated June 2014. Endoscopy. 2014;46:799-815.
67. Espinel J, Pinedo E, Bailador C. Clipping of a post-sphincterotomy bleeding. Rev Esp Enferm Dig. 2010;102:385.
68. Han J, Kim MH. Endoscopic papillectomy for adenomas of the major duodenal papilla (with video). Gastrointest Endosc. 2006;63:292-301.
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Espinel J, Pinedo E, Ojeda V, Guerra del Río M. Endoscopic ampullectomy: a technical review. 3867/2015


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Publication history

Received: 27/05/2015

Accepted: 08/10/2015

Online First: 10/12/2015

Published: 29/04/2016

Article revision time: 128 days

Article Online First time: 197 days

Article editing time: 338 days


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