2807 Endoscopic Management of Tumors of Minor Ampulla: A Multicenter Case Series

Abstract

INTRODUCTION: Ampullary and duodenal carcinoma are aggressive cancers with poor 5 year survival rates. Like colorectal cancer, ampullary and duodenal carcinomas are also thought to follow the adenoma-carcinoma sequence. Ampullectomy is a well-established treatment for early stage carcinoma of major ampulla. Several studies have established its safety and efficacy in the management of major ampullary tumor. However, tumors arising in the minor ampulla are relatively rare and there are no good case series on endoscopic management of these tumors. We report a multicenter case series of endoscopic ampullectomy in the management of minor ampullary tumors. METHODS: To establish the safety and efficacy of endoscopic ampullectomy in the management of minor ampullary tumors. Consecutive patients undergoing ampullectomy for minor ampullary tumor at four hospitals were included in this study over a period of 5 years. A total of 6 patients were included in the study and all six patients underwent ERCP for purpose of minor ampullectomy. MRCP and EUS was performed on all patients prior to ERCP to rule out invasion. Pancreatic stents were placed after ampullectomy in 5 patients. RESULTS: Ampullectomy was technically successful in all 6 patients. One patient required two ERCPs for complete ampullectomy. The tumors varied in size from 1 cm to 3 cm. Pathology revealed adenoma in three patients, adenoma with high grade dysplasia in one patient, carcinoma in one patient, and carcinoid tumor in one patient. One patient (16%) developed post ERCP pancreatitis; this patient was kept in the hospital for 2 days. No other major complications were noted. Follow-up for these patients ranged from 2 to 5 years with EGD using duodenoscope at 3 months, one year and yearly thereafter. One patient had recurrence at 2 years which was thought to be recurrent tumor (4 mm). This patient was treated with repeat ampullectomy. CONCLUSION: This study demonstrates the safety and efficacy of endoscopic removal of minor ampullary tumors. Our case-series showed a comparable rate of procedure-related complication of (16.6%), as one out of six patients was found to have pancreatitis. The other 5 patients had no complications and were discharged within 24 hours. Among the patients who followed up, there were no recurrences of tumor and no patient was found to have cancer develop over a mean follow-up period of 2 to 5 years. This demonstrates that complete removal of these lesions via endoscopic resection is safe and has favorable outcomes.