New experience of endoscopic papillectomy for ampullary neoplasms

Aim To establish the clinical value of endoscopic papillectomy for duodenal papillary tumor based on endoscopic and clinical characteristics. Patients and methods This single-center, retrospective study included 110 patients with duodenal papillary tumor who underwent endoscopic papillectomy between...

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Veröffentlicht in:Surgical endoscopy 2019-02, Vol.33 (2), p.612-619
Hauptverfasser: Li, Shuling, Wang, Zikai, Cai, Fengchun, Linghu, Enqiang, Sun, Gang, Wang, Xiangdong, Meng, Jiangyun, Du, Hong, Yang, Yunsheng, Li, Wen
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container_end_page 619
container_issue 2
container_start_page 612
container_title Surgical endoscopy
container_volume 33
creator Li, Shuling
Wang, Zikai
Cai, Fengchun
Linghu, Enqiang
Sun, Gang
Wang, Xiangdong
Meng, Jiangyun
Du, Hong
Yang, Yunsheng
Li, Wen
description Aim To establish the clinical value of endoscopic papillectomy for duodenal papillary tumor based on endoscopic and clinical characteristics. Patients and methods This single-center, retrospective study included 110 patients with duodenal papillary tumor who underwent endoscopic papillectomy between January 2006 and April 2017 at the gastrointestinal endoscopic center of the Chinese PLA General Hospital. Clinical data, postoperative pathology, procedure-related complications, and therapeutic outcomes were analyzed. Results Endoscopic papillectomy was technically feasible in all patients, and was mainly performed by four experienced endoscopists. The primary success rate of endoscopic papillectomy for ampullary neoplasms was 78.2%. A total of 13 patients experienced recurrence during a mean follow-up period of 16.28 months (range 6–132 months), the predictive factors that were related to recurrence were complete resection (53.8% vs. 94.2%; P  = 0.001), and final pathology findings ( P  = 0.001). Delayed hemorrhage, the most common procedure-related complication, occurred in 20% (22/110) of patients and was significantly related to intraoperative bleeding ( P  = 0.042). Pancreatitis was the second most common complication, which was closely related to intraoperative bleeding requiring intervention ( P  = 0.040) and larger tumor size ( P  = 0.044). Histology, type of resection, stent placement, sphincterotomy, and duration of procedure were not related to post-procedure hemorrhage or pancreatitis. Older age (63.7 ± 13.5 vs. 57.4 ± 12.2; P  = 0.033), jaundice (47.8% vs. 13.8%; P  = 0.001), endoscopic forceps biopsy diagnosis of high-grade intraepithelial neoplasia (82.6% vs. 14.9%; P  = 0.001), tumor size ≥ 2 cm (60.9% vs. 34.5%; P  = 0.022), and dilation of the bile duct (34.8% vs. 9.2%; P  = 0.006) were clinical features for ampullary carcinoma. The rate of complete resection (52.2% vs. 92.0%; P  = 0.001) and recurrence (34.8% vs. 6.8%; P  = 0.001) were also related to the diagnosis of ampullary carcinoma at final pathology. Conclusions Endoscopic papillectomy is a feasible and reasonable option for both diagnosis and treatment of tumors of the duodenal papilla in properly selected patients.
doi_str_mv 10.1007/s00464-018-6577-2
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Patients and methods This single-center, retrospective study included 110 patients with duodenal papillary tumor who underwent endoscopic papillectomy between January 2006 and April 2017 at the gastrointestinal endoscopic center of the Chinese PLA General Hospital. Clinical data, postoperative pathology, procedure-related complications, and therapeutic outcomes were analyzed. Results Endoscopic papillectomy was technically feasible in all patients, and was mainly performed by four experienced endoscopists. The primary success rate of endoscopic papillectomy for ampullary neoplasms was 78.2%. A total of 13 patients experienced recurrence during a mean follow-up period of 16.28 months (range 6–132 months), the predictive factors that were related to recurrence were complete resection (53.8% vs. 94.2%; P  = 0.001), and final pathology findings ( P  = 0.001). Delayed hemorrhage, the most common procedure-related complication, occurred in 20% (22/110) of patients and was significantly related to intraoperative bleeding ( P  = 0.042). Pancreatitis was the second most common complication, which was closely related to intraoperative bleeding requiring intervention ( P  = 0.040) and larger tumor size ( P  = 0.044). Histology, type of resection, stent placement, sphincterotomy, and duration of procedure were not related to post-procedure hemorrhage or pancreatitis. Older age (63.7 ± 13.5 vs. 57.4 ± 12.2; P  = 0.033), jaundice (47.8% vs. 13.8%; P  = 0.001), endoscopic forceps biopsy diagnosis of high-grade intraepithelial neoplasia (82.6% vs. 14.9%; P  = 0.001), tumor size ≥ 2 cm (60.9% vs. 34.5%; P  = 0.022), and dilation of the bile duct (34.8% vs. 9.2%; P  = 0.006) were clinical features for ampullary carcinoma. The rate of complete resection (52.2% vs. 92.0%; P  = 0.001) and recurrence (34.8% vs. 6.8%; P  = 0.001) were also related to the diagnosis of ampullary carcinoma at final pathology. Conclusions Endoscopic papillectomy is a feasible and reasonable option for both diagnosis and treatment of tumors of the duodenal papilla in properly selected patients.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-018-6577-2</identifier><identifier>PMID: 30421083</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abdominal Surgery ; Adult ; Aged ; Ampulla of Vater - pathology ; Ampulla of Vater - surgery ; Biopsy - methods ; Duodenal Neoplasms - pathology ; Duodenal Neoplasms - surgery ; Endoluminal Surgery ; Endoscopy ; Endoscopy, Digestive System - adverse effects ; Endoscopy, Digestive System - methods ; Feasibility Studies ; Female ; Gastroenterology ; Gynecology ; Hepatology ; Humans ; Male ; Medicine ; Medicine &amp; Public Health ; Middle Aged ; Neoplasm Staging ; Pancreatitis ; Pathology ; Proctology ; Retrospective Studies ; Surgery ; Treatment Outcome ; Tumors</subject><ispartof>Surgical endoscopy, 2019-02, Vol.33 (2), p.612-619</ispartof><rights>Springer Science+Business Media, LLC, part of Springer Nature 2018</rights><rights>Surgical Endoscopy is a copyright of Springer, (2018). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c438t-8d36dd79bdedd62c2c7b761899a9610dc49e4012564cb0b297af76cf7dd982d73</citedby><cites>FETCH-LOGICAL-c438t-8d36dd79bdedd62c2c7b761899a9610dc49e4012564cb0b297af76cf7dd982d73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-018-6577-2$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-018-6577-2$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30421083$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Li, Shuling</creatorcontrib><creatorcontrib>Wang, Zikai</creatorcontrib><creatorcontrib>Cai, Fengchun</creatorcontrib><creatorcontrib>Linghu, Enqiang</creatorcontrib><creatorcontrib>Sun, Gang</creatorcontrib><creatorcontrib>Wang, Xiangdong</creatorcontrib><creatorcontrib>Meng, Jiangyun</creatorcontrib><creatorcontrib>Du, Hong</creatorcontrib><creatorcontrib>Yang, Yunsheng</creatorcontrib><creatorcontrib>Li, Wen</creatorcontrib><title>New experience of endoscopic papillectomy for ampullary neoplasms</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Aim To establish the clinical value of endoscopic papillectomy for duodenal papillary tumor based on endoscopic and clinical characteristics. Patients and methods This single-center, retrospective study included 110 patients with duodenal papillary tumor who underwent endoscopic papillectomy between January 2006 and April 2017 at the gastrointestinal endoscopic center of the Chinese PLA General Hospital. Clinical data, postoperative pathology, procedure-related complications, and therapeutic outcomes were analyzed. Results Endoscopic papillectomy was technically feasible in all patients, and was mainly performed by four experienced endoscopists. The primary success rate of endoscopic papillectomy for ampullary neoplasms was 78.2%. A total of 13 patients experienced recurrence during a mean follow-up period of 16.28 months (range 6–132 months), the predictive factors that were related to recurrence were complete resection (53.8% vs. 94.2%; P  = 0.001), and final pathology findings ( P  = 0.001). Delayed hemorrhage, the most common procedure-related complication, occurred in 20% (22/110) of patients and was significantly related to intraoperative bleeding ( P  = 0.042). Pancreatitis was the second most common complication, which was closely related to intraoperative bleeding requiring intervention ( P  = 0.040) and larger tumor size ( P  = 0.044). Histology, type of resection, stent placement, sphincterotomy, and duration of procedure were not related to post-procedure hemorrhage or pancreatitis. Older age (63.7 ± 13.5 vs. 57.4 ± 12.2; P  = 0.033), jaundice (47.8% vs. 13.8%; P  = 0.001), endoscopic forceps biopsy diagnosis of high-grade intraepithelial neoplasia (82.6% vs. 14.9%; P  = 0.001), tumor size ≥ 2 cm (60.9% vs. 34.5%; P  = 0.022), and dilation of the bile duct (34.8% vs. 9.2%; P  = 0.006) were clinical features for ampullary carcinoma. The rate of complete resection (52.2% vs. 92.0%; P  = 0.001) and recurrence (34.8% vs. 6.8%; P  = 0.001) were also related to the diagnosis of ampullary carcinoma at final pathology. 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Public Health</topic><topic>Middle Aged</topic><topic>Neoplasm Staging</topic><topic>Pancreatitis</topic><topic>Pathology</topic><topic>Proctology</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Li, Shuling</creatorcontrib><creatorcontrib>Wang, Zikai</creatorcontrib><creatorcontrib>Cai, Fengchun</creatorcontrib><creatorcontrib>Linghu, Enqiang</creatorcontrib><creatorcontrib>Sun, Gang</creatorcontrib><creatorcontrib>Wang, Xiangdong</creatorcontrib><creatorcontrib>Meng, Jiangyun</creatorcontrib><creatorcontrib>Du, Hong</creatorcontrib><creatorcontrib>Yang, Yunsheng</creatorcontrib><creatorcontrib>Li, Wen</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing &amp; 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Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Li, Shuling</au><au>Wang, Zikai</au><au>Cai, Fengchun</au><au>Linghu, Enqiang</au><au>Sun, Gang</au><au>Wang, Xiangdong</au><au>Meng, Jiangyun</au><au>Du, Hong</au><au>Yang, Yunsheng</au><au>Li, Wen</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>New experience of endoscopic papillectomy for ampullary neoplasms</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2019-02-01</date><risdate>2019</risdate><volume>33</volume><issue>2</issue><spage>612</spage><epage>619</epage><pages>612-619</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Aim To establish the clinical value of endoscopic papillectomy for duodenal papillary tumor based on endoscopic and clinical characteristics. Patients and methods This single-center, retrospective study included 110 patients with duodenal papillary tumor who underwent endoscopic papillectomy between January 2006 and April 2017 at the gastrointestinal endoscopic center of the Chinese PLA General Hospital. Clinical data, postoperative pathology, procedure-related complications, and therapeutic outcomes were analyzed. Results Endoscopic papillectomy was technically feasible in all patients, and was mainly performed by four experienced endoscopists. The primary success rate of endoscopic papillectomy for ampullary neoplasms was 78.2%. A total of 13 patients experienced recurrence during a mean follow-up period of 16.28 months (range 6–132 months), the predictive factors that were related to recurrence were complete resection (53.8% vs. 94.2%; P  = 0.001), and final pathology findings ( P  = 0.001). Delayed hemorrhage, the most common procedure-related complication, occurred in 20% (22/110) of patients and was significantly related to intraoperative bleeding ( P  = 0.042). Pancreatitis was the second most common complication, which was closely related to intraoperative bleeding requiring intervention ( P  = 0.040) and larger tumor size ( P  = 0.044). Histology, type of resection, stent placement, sphincterotomy, and duration of procedure were not related to post-procedure hemorrhage or pancreatitis. Older age (63.7 ± 13.5 vs. 57.4 ± 12.2; P  = 0.033), jaundice (47.8% vs. 13.8%; P  = 0.001), endoscopic forceps biopsy diagnosis of high-grade intraepithelial neoplasia (82.6% vs. 14.9%; P  = 0.001), tumor size ≥ 2 cm (60.9% vs. 34.5%; P  = 0.022), and dilation of the bile duct (34.8% vs. 9.2%; P  = 0.006) were clinical features for ampullary carcinoma. The rate of complete resection (52.2% vs. 92.0%; P  = 0.001) and recurrence (34.8% vs. 6.8%; P  = 0.001) were also related to the diagnosis of ampullary carcinoma at final pathology. Conclusions Endoscopic papillectomy is a feasible and reasonable option for both diagnosis and treatment of tumors of the duodenal papilla in properly selected patients.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>30421083</pmid><doi>10.1007/s00464-018-6577-2</doi><tpages>8</tpages></addata></record>
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subjects Abdominal Surgery
Adult
Aged
Ampulla of Vater - pathology
Ampulla of Vater - surgery
Biopsy - methods
Duodenal Neoplasms - pathology
Duodenal Neoplasms - surgery
Endoluminal Surgery
Endoscopy
Endoscopy, Digestive System - adverse effects
Endoscopy, Digestive System - methods
Feasibility Studies
Female
Gastroenterology
Gynecology
Hepatology
Humans
Male
Medicine
Medicine & Public Health
Middle Aged
Neoplasm Staging
Pancreatitis
Pathology
Proctology
Retrospective Studies
Surgery
Treatment Outcome
Tumors
title New experience of endoscopic papillectomy for ampullary neoplasms
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