Endoscopic ampullectomy: a Medical Research Institute experience

Background Ampullary tumors account for 10% of periampullary neoplasms and can occur sporadically or in the setting of familial polyposis syndromes. Although classified as benign, ampullary adenomas are premalignant neoplasms arising from the mucosa. It is thought that the adenoma-to-carcinoma sequence does occur for these lesions. Grossly and histologically, these lesions are similar to the adenomas arising in the mucosa of the large intestine. As regards the lesion assessment of ampullary tumors, multimodality tumor staging is essential before endoscopic resection, which includes endoscopic appearance, histology, endoscopic ultrasound, magnetic resonance cholangiopancreatography, and endoscopic retrograde cholangiopancreatography. Patients and methods From 2013 to 2015, 20 patients admitted to the Endoscopy Unit of the Medical Research Institute Hospital, Alexandria University, underwent endoscopic ampullectomy for presumed benign tumors of the ampulla of Vater with complete follow-up for 1 year until February 2016. Endoscopic resection technique Complete en-bloc excision of the entire neoplasm to the plane of the duodenal wall was carried out. Results Successful ampullectomy was performed in all cases. As regards the pathology of lesions, 10 (50%) patients had tubulovillous adenoma, seven (35%) patients had villous adenoma, one (5%) patient had tubulovillous adenoma with dysplasia, one (5%) patient had adenocarcinoma, and one (5%) patient had carcinoid tumor. Only three (30%) patients with proven malignancy underwent pancreaticoduodenectomy. There were no recurrences in all benign cases, with the only reported complication being bleeding in three malignant cases. Conclusion Endoscopic ampullectomy is a safe and effective therapy for papillary adenomas, when performed by experienced endoscopists. However, there is a substantial incidence of moderate-to-severe complications that the endoscopist must be prepared to identify and manage.