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surgical ampullectomy:A comprehensive review

World Journal of Gastrointestinal Surgery 2021年第11期13卷 1338-1350页

作者： Darren L Scroggie Vasileios K Mavroeidis Department of Population Health Sciences Bristol Centre for Surgical ResearchBristol Medical SchoolBristol BS82PSUnited Kingdom Department of HPB Surgery University Hospitals Bristol and Weston NHS Foundation TrustBristol Royal InfirmaryBristol BS28HWUnited Kingdom Department of Surgery The Royal Marsden NHS Foundation TrustLondon SW36JJUnited Kingdom

Tumours of the ampulla of Vater are relatively uncommon lesions of the digestive *** are typically diagnosed at an earlier stage than other types of tumours in this region,due to their tendency to invoke symptoms by obstructing the bile duct or pancreatic ***,many are potentially curable by *** ampullectomy(SA)(or transduodenal ampullectomy)for an ampullary tumour was first described in 1899,but was soon surpassed by pancreatoduodenectomy(PD),which offered a more extensive resection resulting in a lower risk of *** innovation in endoscopic techniques over recent decades has led to the popularization of endoscopic papillectomy(EP),particularly for adenomas and even early *** vast majority of resectable ampullary tumours are now treated using either PD or ***,SA continues to play a role in specific *** authors have suggested specific indications for SA based on their own data,practices,or interpretations of the ***,certain issues have attracted controversy,such as its use for early ampullary ***,there has been a lack of clarity regarding indications for SA,and no evidence-based consensus guidelines have been *** studies reporting SA have employed observational designs,and have been heterogeneous in their ***,characteristics of patients and their tumours have differed substantially across treatment ***,meaningful comparisons of clinical outcomes between SA,PD and EP have been ***,it appears that suitably selected cases of ampullary tumours subjected to SA may benefit from favourable peri-operative and long-term outcomes with very low mortality and significantly long survival,hence its role in this setting warrants further clarification,while it can also be useful in the management of specific benign *** the commissioning of a randomised controlled trial seems unlikely,well-designed obse

关键词： Ampulla of Vater Ampullary tumours surgical ampullectomy Transduodenal ampullectomy Endoscopic papillectomy Pancreatoduodenectomy

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Endoscopic papillectomy: The limits of the indication, technique and results

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World Journal of Gastrointestinal Endoscopy 2015年第10期7卷 987-994页

作者： Jose Celso Ardengh Rafael Kemp Eder Rios Lima-Filho Jose Sebastiao dos Santos Division of Digestive and Endoscopic Surgery Department of Surgery and Anatomy Ribeirao Preto School of Medicine University of Sao Paulo Department of Surgery Hospital Federal dos Servidores do Estado Rua Sacadura Cabral Rio de Janeiro 20221-903 Brazil

In the majority of cases, duodenal papillary tumors are adenomas or adenocarcinomas, but the endoscopy biopsy shows low accuracy to make the correct differentiation. Endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography are important tools for the diagnosis, staging and management of ampullary lesions. Although the endoscopic papillectomy(EP) represent higher risk endoscopic interventions, it has successfully replaced surgical treatment for benign or malignant papillary tumors. The authors review the epidemiology and discuss the current evidence for the use of endoscopic procedures for resection, the selection of the patient and the preventive maneuvers that can minimize the probability of persistent or recurrent lesions and to avoid complications after the procedure. The accurate staging of ampullary tumors is important for selecting patients to EP or surgical treatment. Compared to surgery, EP is associated with lower morbidity and mortality, and seems to be a preferable modality of treatment for small benign ampullary tumors with no intraductal extension. The EP procedure, when performed by an experienced endoscopist, leads to successful eradication in up to 85% of patients with ampullary adenomas. EP is a safe and effective therapy and should be established as the first-line therapy for ampullary adenomas.

关键词： Epidemiology Ampullary tumors Endo-scopic resection Endoscopic ultrasound Staging Endoscopic papillectomy surgical ampullectomy

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