S0921 Pancreatitis Following Endoscopic Resection of Ampullary Masses: A Single Center Retrospective Study

Abstract

INTRODUCTION: Endoscopic resection of ampullary masses has emerged as an effective and first line treatment approach compared to surgery. Post-ampullectomy pancreatitis is a potential significant adverse outcome of endoscopic resection. The effectiveness of prophylactic pancreatic duct stent during ampullectomy is unclear, however it is considered widely. We aim to evaluate factors associated with post-ampullectomy pancreatitis and the role of prophylactic pancreatic duct stenting. METHODS: A retrospective review was performed of patients who underwent endoscopic ampullectomy of ampullary masses using craniocaudal snare technique 2003–2019 at Georgetown University Hospital. Z-test and descriptive statistics were used. RESULTS: 90 patients underwent ampullectomy for ampullary mass. 11.1% (10/90) developed pancreatitis. 5.6% (3/54) of patients with adenomas developed pancreatitis, compared to 19.4% (7/36) of patients with non-adenomas (P = 0.04). Of the 10 patients who developed pancreatitis compared to those that did not develop pancreatitis, average age was 58.2 y (vs 59 y, P = 0.89). Average adenoma size was 1.19 cm (vs. 1.36 cm, P = 0.5). 50% were male. 100% had PD stents placed (P = 0.17), and 10% underwent APC (vs. 14.4%, P = 0.67). Pathology of the masses showed 3 adenoma, 1 carcinoma, 1 gangliocytic paraganglioma, 3 normal mucosa, 1 adenomyoma, and 1 granulation tissue. CONCLUSION: Ampullectomy offers patients with ampullary masses an intervention with high success rates and decreased morbidity and mortality, compared to surgery. However, ampullectomy confers increased risk for postoperative pancreatitis. We observed a pancreatitis rate of 11.1%, similar to reported rates ranging from 4.5% to 33%. Our use of craniocaudal snare technique, compared to caudocranial, may explain our relatively lower pancreatitis rates. Identifying risk factors for post ampullectomy pancreatitis is challenging and the literature is sparse. In our cohort, we observed a statistically significant increase in pancreatitis among patients with non-adenomas. There was no significant difference by age, mass size, use of PD stent, or use of APC between patients who developed pancreatitis and those that did not. All patients in our cohort who developed pancreatitis had prophylactic PD stents placed. Ultimately, our single-center study is limited by a small sample size and selection bias, and there is a need for further studies to determine which factors contribute the most to post-ampullectomy pancreatitis.Table 1.: Patient CharacteristicsGraph 1.: Pancreatitis in Patients with Adenoma vs. Non-Adenoma.