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Clinicopathologic characteristics associated with complications and long-term outcomes of endoscopic papillectomy for adenoma.

Abstract：

PURPOSE:Endoscopic papillectomy (EP) is currently employed for the treatment of ampullary adenoma. This study aimed to evaluate the clinical, endoscopic, and histologic characteristics related to complications and long-term outcomes of EP. MATERIALS AND METHODS:Thirty-nine patients underwent EP for ampullary adenoma. Patients were grouped according to the occurrence of procedure-related complications: no complication group (n=28) and complication group (n=11). RESULTS:The overall complication rate was 28.2%. The most common complication was EP-related pancreatitis (n=7). Amylase (p=0.006) and lipase levels (p=0.007), 24 hours after EP, were significantly higher in the complication group, however, these levels did not differ at earlier times. As the tumor progressed from adenoma to cancer, the complete resection was significantly lessened (p=0.032). The duration of antiprotease injection during the hospital stay was significantly longer (p=0.017) and the transfusion requirements were significantly higher (p=0.018) in the complication group. During a median follow-up of 15 months, three lesions (10.3%) recurred among patients with complete resection (n=29) and five lesions (12.8%) recurred among enrolled patients. One patient with progressive recurrence from low-grade dysplasia to adenocarcinoma was noted during a follow-up of 22 months. CONCLUSION:If symptoms are present, amylase and lipase levels, 24 hours after EP, could help predict possible EP-related pancreatitis. Histologic diagnosis through resected specimens may result in complete resection. Patients with complications need a longer duration of antiprotease injection during their hospital stay and more transfusions. The recurrence rate was not significantly high in completely resected cases, however, there was a possibility of progressive recurrence.

journal_name

Yonsei Med J

journal_title

Yonsei medical journal

authors

Shim CN,Chung MJ,Bang S,Park SW,Song SY,Chung JB,Park JY

doi

10.3349/ymj.2014.55.3.644

subject

Has Abstract

pub_date

2014-05-01 00:00:00

pages

644-50

issue

eissn

0513-5796

issn

1976-2437

pii

201405644

journal_volume

pub_type

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Clinicopathologic characteristics associated with complications and long-term outcomes of endoscopic papillectomy for adenoma.